Avulsion of the common bile duct and ampulla of vater after blunt abdominal trauma: Case report and review of the literature

Abstract

Introduction: Extrahepatic bile ducts injuries from blunt abdominal trauma are very rare. The criticality and the difficulty of these injuries are increased by the duodenal wall and the main pancreatic duct injuries. These injuries therefore require special consideration. Diagnosis is always difficult and late and depends on suspicion. Proper management depends on the efficiency of the center, the surgeon and the severity of the injury. Case Report: A 28­year­old male presented to the emergency unit complaining of falling from motor cycle. The patient was stable. Urgent ultrasound revealed mild intraperitoneal collection. Computerized tomography with contrast showed the same finding with left sided pleural effusion and fracture fifth rib. The patient’s condition began to deteriorate with time. Immediate exploration revealed complete avulsion of the CBD from the duodenum. Exteriorization of the CBD to outside the abdomen through the skin was done. The diagnosis of avulsion of the CBD from the sphincter of Oddi was a retrospective diagnosis. Conclusion: Simple maneuvers can be performed that will not harm the patient and may be of great benefit. In the present case, exteriorization of the CBD to outside by a simple urinary catheter gave us the chance to have an accurate postoperative diagnosis which was not available at the time of the operation. Drainage of the pancreatic and biliary secretions outside the abdomen with no added morbidities also gave us the chance and the time needed to treat other associated complications like respiratory problems.