title: Extrahepatic duct injury in blunt trauma: two case reports and a literature review.
abstract: Traumatic injuries of the extrahepatic biliary tract are rare. Associated injuries are usually responsible for immediate indication for surgical treatment, the time when an injury to the extrahepatic biliary ducts may be diagnosed. However, missed injuries are often common. The primary aim of this paper is to describe the clinical features, diagnosis, treatment, and outcome of two patients with left hepatic duct injury after blunt abdominal trauma. As a secondary objective, a literature review is presented. The two cases presented in this study are as follows: (1) A young male, involved in a motor vehicle crash, was admitted with blunt hepatic trauma in a general hospital. Endoscopic retrograde cholangiography was conducted 3 weeks later and revealed a large leakage at the left hepatic duct. Exploratory laparotomy was performed 26 days after the initial traumatic event and identified a complete section of the left hepatic duct, treated with anastomosis. (2) A male fell from a height. On exploratory laparotomy, a 30 % partial injury of the left hepatic duct was found in addition to hemoperitoneum, liver injury, gallbladder detachment together with cystic duct rupture, retroperitoneal hematoma to the right, and cecum hematoma. A high level of suspicion is necessary to identify injuries to the hepatic ducts. Early diagnosis that occurs during laparotomy due to associated injuries is important to reduce complications.
authors.affiliation: Division of Trauma Surgery, University of Campinas, Campinas, Brazil ; Cidade Universitaria "Prof. Zeferino Vaz", Rua Alexander Fleming, 181, 13.083-970 Campinas, São Paulo Brazil.
authors.forename: Thiago Messias
authors.initials: TM
authors.lastname: Zago
authors.affiliation: Division of Trauma Surgery, University of Campinas, Campinas, Brazil.
authors.forename: Bruno Monteiro Tavares
authors.initials: BM
authors.lastname: Pereira
authors.affiliation: Division of Trauma Surgery, University of Campinas, Campinas, Brazil.
authors.forename: Thiago Rodrigues Araujo
authors.initials: TR
authors.lastname: Calderan
authors.affiliation: Division of Trauma Surgery, University of Campinas, Campinas, Brazil.
authors.forename: Elcio Shiyoiti
authors.initials: ES
authors.lastname: Hirano
authors.affiliation: Division of Trauma Surgery, University of Campinas, Campinas, Brazil.
authors.forename: Gustavo Pereira
authors.initials: GP
authors.lastname: Fraga
keywords: Abdominal injuries; Bile ducts; Biliary tract surgical procedures; Delayed diagnosis; Extrahepatic; Wounds and injuries