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Extra-Hepatic Bile Duct Injury in Blunt Trauma; A Systematic Review.
Journal of Trauma and Acute Care Surgery 2019 January 9
BACKGROUND: Extra-hepatic bile duct injuries (EHBDIs) are a rare consequence of blunt abdominal trauma. The purpose of this study was to establish mechanisms of injury, clinical indicators of EHBDI following blunt trauma (both with investigative modalities and intraoperatively), method and timing of injury detection, and definitive treatment options.
METHOD: A Systematic Review was performed to gather data on patients with an extrahepatic bile duct injury secondary to blunt trauma. Three databases (MEDLINE, PubMed, and EMBASE) were searched to 19 July 2018.
RESULTS: Our systematic review included 51 studies, compromising a study population of 66 patients with EHBDIs sustained from blunt trauma. The three most common injuries included complete transection of the suprapancreatic common bile duct (CBD) (29%, n = 19), complete transection of the intrapancreatic CBD (23%, n = 15) and partial laceration of the left hepatic duct (20%, n = 13). Of the haemodynamically stable group managed non-operatively (n=23), mean timing post injury to diagnosis of EHBDI was 11 days. An EHBDI was recognized at initial laparotomy in 87% (n=13) of hemodynamically stable patients. An EHBDI was recognized at initial laparotomy in 57% (n=8) of hemodynamically unstable patients.
CONCLUSION: EHBDIs are a rare yet serious consequence of blunt trauma. To establish a timely diagnosis and limit complications of missed injuries, a heightened awareness is required by the attending surgeon with particular attention to subtle yet important clinical indicators. These vary depending on the haemodynamic stability of the patient and decision to manage injuries conservatively or surgically on presentation.
LEVEL OF EVIDENCE: Level 3 Systematic Review.
METHOD: A Systematic Review was performed to gather data on patients with an extrahepatic bile duct injury secondary to blunt trauma. Three databases (MEDLINE, PubMed, and EMBASE) were searched to 19 July 2018.
RESULTS: Our systematic review included 51 studies, compromising a study population of 66 patients with EHBDIs sustained from blunt trauma. The three most common injuries included complete transection of the suprapancreatic common bile duct (CBD) (29%, n = 19), complete transection of the intrapancreatic CBD (23%, n = 15) and partial laceration of the left hepatic duct (20%, n = 13). Of the haemodynamically stable group managed non-operatively (n=23), mean timing post injury to diagnosis of EHBDI was 11 days. An EHBDI was recognized at initial laparotomy in 87% (n=13) of hemodynamically stable patients. An EHBDI was recognized at initial laparotomy in 57% (n=8) of hemodynamically unstable patients.
CONCLUSION: EHBDIs are a rare yet serious consequence of blunt trauma. To establish a timely diagnosis and limit complications of missed injuries, a heightened awareness is required by the attending surgeon with particular attention to subtle yet important clinical indicators. These vary depending on the haemodynamic stability of the patient and decision to manage injuries conservatively or surgically on presentation.
LEVEL OF EVIDENCE: Level 3 Systematic Review.
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