Management of blunt and penetrating biliary tract trauma.
BACKGROUND
Penetrating or blunt injury to the biliary tree remains a rare complication of trauma occurring in 0.1% of trauma admissions. Because of the different presentations, sites of biliary tract injury, and associated organ injury, there are many possible management pathways to be considered.


METHODS
A retrospective analysis of prospectively gathered data was performed for all gallbladder and biliary tract injuries presenting to the trauma service or hepatobiliary unit of the Royal Melbourne Hospital between January 1, 1999, and March 30, 2011.


RESULTS
There were 33 biliary injuries in 30 patients (0.1%) among 26,014 trauma admissions. Three of the 30 patients (10%) died. Of 10 gallbladder injuries, 8 were managed with cholecystectomy. There were 23 injuries to the biliary tree. Fourteen patients had injuries to the intrahepatic biliary tree of which seven involved segmental ducts. Of these, four segmental duct injuries required hepatic resection or debridement. Nine patients had injury to the extrahepatic biliary tree of which five required T-tube placement ± bilioenteric anastomosis and one a pancreaticoduodenectomy.


CONCLUSIONS
Biliary injury is a rare but important consequence of abdominal trauma, and good outcomes are possible when a major trauma center and hepatopancreaticobiliary service coexist. Cholecystectomy remains the gold standard for gallbladder injury. Drainage with or without endoscopic stenting will resolve the majority of intrahepatic and partial biliary injuries. Hepaticojejunostomy remains the gold standard for complete extrahepatic biliary disruption. Hepatic and pancreatic resection are only required in the circumstances of unreconstructable biliary injury.


METHODS
Therapeutic study, level V.
Trauma Service, Royal Melbourne Hospital, Victoria, Australia. ben.thomson@petermac.org
Benjamin N J
BN
Thomson
Benson
B
Nardino
Kellie
K
Gumm
Amanda J
AJ
Robertson
Brett P
BP
Knowles
Neil A
NA
Collier
Rodney
R
Judson
D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D001659:Biliary Tract / Q000293:injuries*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005704:Gallbladder / Q000293:injuries / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014739:Victoria; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D055815:Young Adult