Biliary Trauma

Updated: Jun 09, 2017
  • Author: Frederick Merrill Karrer, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Overview

Background

Isolated injury to the extrahepatic biliary tract and/or the gallbladder is an uncommon event. Predisposing mechanisms include blunt right upper quadrant force, deceleration injuries, penetrating injuries and, most commonly, iatrogenic injury after cholecystectomy.

This article considers both blunt and penetrating trauma to the extrahepatic biliary tract and the gallbladder as well as bile duct injury after cholecystectomy.

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Pathophysiology

Typically, a mechanism of crushing or shear injury to the right upper quadrant causes biliary disruption and subsequent bile-peritonitis. The retroduodenal region of the superior portion of the pancreas is the most common site of biliary transection following blunt trauma, possibly secondary to the relative fixation of the bile duct in that location. The average delay until diagnosis is reportedly 9 days and ranges from hours to 9 months. A perforation or an avulsion of the gallbladder from a blunt thoracoabdominal trauma is extremely rare; penetrating abdominal trauma is a more frequent cause of gallbladder injuries.

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Epidemiology

Frequency

Although the exact incidence of nonoperative biliary trauma is unknown, isolated biliary injury without trauma to associated intra-abdominal structures is extremely rare (less than 1% of all blunt abdominal injuries in most series). Fewer than 40 cases of common bile duct avulsion following blunt trauma are reported; however, it is much rarer than penetrating trauma and more difficult to diagnose.

A study by Halbert et al reported that the rate of ate of bile duct injury following laparoscopic cholecystectomy has now decreased to 0.08 % in New York State. [1]

Mortality/Morbidity

See the list below:

  • Mortality depends directly on the delay in the diagnosis and the treatment, as well as on the severity of the injury.
  • Patients with lesions that are promptly discovered and appropriately treated within hours of injury have a mortality rate of less than 10%, while patients with extensive injuries and delayed treatment may have a mortality rate nearing 40%.
  • Most of the morbidity associated with the extrahepatic biliary tract is related to bile leak and vascular injuries within the hepatoduodenal ligament (hepatic artery/portal vein).

Sex

No gender predilection exists.

Age

Biliary trauma can occur at any age but, just like all blunt and penetrating trauma, it is more common in adolescents and young adults. [2]

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