Biliary Trauma Clinical Presentation

Updated: Mar 27, 2020
  • Author: Frederick Merrill Karrer, MD, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Presentation

History

Clinicians should suspect biliary trauma when a patient presents following a significant blunt force injury to the right thoracoabdominal region. Mechanisms of injury include motor vehicle deceleration injuries, falls, and assaults. 

Penetrating trauma to the biliary tract may be suspected based on the external trajectory of the object, specifically in stab wounds. In gunshot wounds to the abdomen, which may have a varied intra-abdominal trajectory, the path of injury may be less obvious.  

 

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Physical Examination

Among patients who present in shock at the time of injury, the source is likely hemorrhagic from associated injuries and not due to a biliary injury. As noted above, chemical peritonitis may develop; however, with minimal bile leakage, peritonitis may not occur initially, and abdominal signs may be absent. Thus, physical examination findings are often nonspecific. Late physical findings, on the other hand, may include right upper quadrant pain, peritonitis, and jaundice. Signs specific for trauma to the biliary system include the following:

  • Jaundice may be observed as early as 3-5 days after injury; however, it may take several weeks to become obvious.
  • Increasing abdominal girth from biliary ascites, accompanied by signs of dehydration, may develop during the first week after trauma.
  • Following a laparotomy, missed bile duct injuries may present with bile-stained drainage from the incision or a drain, if present.
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