Skip to main content
SpringerLink
Log in

Extrahepatic Biliary System

  • Chapter
  • First Online:
Operative Techniques for Severe Liver Injury

  • 1490 Accesses

Abstract

Although rare in even the busiest trauma centers, lacerations, transections, or avulsions of the extrahepatic biliary ducts occur in patients who have experienced either blunt or penetrating abdominal trauma. The diagnosis is difficult in the patient undergoing observation only after blunt abdominal trauma and may not be made for several weeks. Also, ductal injuries have been missed at operation in patients with associated injuries to the hilum of the liver or pancreatoduodenal complex. Scanning with HIDA, endoscopic retrograde cholangiography, and intraoperative cholangiography have been useful in detecting occult ductal injuries. The technique of repair in stable patients depends primarily on the location and extent of the ductal injury and has ranged from lateral choledochorrhaphy with absorbable sutures to biliary enteric bypass. T-tubes or stents continue to be used because of the small size of the ductal system, although no agreement exists on how long they should remain in place after operation. Results of biliary enteric bypass operations for complex injuries are excellent as long as the tenuous blood supply of the bile duct is preserved and the anastomosis is tension free.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Feliciano DV, Bitondo CG, Burch JM, Mattox KL, Beall Jr AC, Jordan Jr GL. Management of traumatic injuries to the extrahepatic biliary ducts. Am J Surg. 1985;150:705–9.

    Article  PubMed  CAS  Google Scholar 

  2. Ivatury RR, Rohman M, Nallathambi M, Rao PM, Gunduz Y, Stahl WM. The morbidity of injuries of the extra-hepatic biliary system. J Trauma. 1985;25:967–73.

    Article  PubMed  CAS  Google Scholar 

  3. Jurkovich GJ, Hoyt DB, Moore FA, Ney AL, Morris Jr JA, Scalea TM, et al. Portal triad injuries – a multicenter study. J Trauma. 1995;39:426–34.

    Article  PubMed  CAS  Google Scholar 

  4. Rodriguez-Mentes JA, Rojo E, Martin LG-S. Complications following repair of extrahepatic bile duct injuries after blunt abdominal trauma. World J Surg. 2001;25:1313–6.

    Article  Google Scholar 

  5. Michelassi F, Ranson JHC. Bile duct disruption by blunt trauma. J Trauma. 1985;25:454–7.

    Article  PubMed  CAS  Google Scholar 

  6. Busuttil RW, Kitahama A, Cerise E, McFadden M, Lo R, Longmire Jr WP. Management of blunt and penetrating injuries to the porta hepatis. Ann Surg. 1980;191:641–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. Kitahama A, Elliott LF, Overby JL, Webb WR. The extrahepatic biliary tract injury. Perspectives in diagnosis and treatment. Ann Surg. 1982;196:536–40.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Drysdale TM. Case of rupture of the common duct of the liver. Formation of a cyst containing bile. Death occurring on the fifty-third day. Autopsy. Am J Med Sci. 1861;12:399–404.

    Google Scholar 

  9. Feliciano DV. Biliary injuries as a result of blunt and penetrating trauma. Surg Clin North Am. 1994;74:897–907.

    PubMed  CAS  Google Scholar 

  10. Battle NH. Traumatic rupture of the common bile duct. Trans Clin Soc Lond. 1894;27:144–8.

    Google Scholar 

  11. Zollinger Jr RM, Keller RT, Hubay CA. Traumatic rupture of the right and left hepatic ducts. J Trauma. 1972;12:563–9.

    Article  PubMed  Google Scholar 

  12. Fletcher WS, Mahnke DE, Dunphy JE. Complete division of the common bile duct due to blunt trauma. Report of a case and review of the literature. J Trauma. 1961;1:87–95.

    Article  PubMed  CAS  Google Scholar 

  13. Lee JG, Wherry DC. Traumatic rupture of the extrahepatic biliary ducts from external trauma. J Trauma. 1961;1:105–14.

    Article  PubMed  CAS  Google Scholar 

  14. Maier WP, Lightfoot WP, Rosemond GP. Extrahepatic biliary ductal injury in closed trauma. Am J Surg. 1968;116:103–8.

    Article  PubMed  CAS  Google Scholar 

  15. Haynes CD, Given KS, Stone HH, Smith RB III. Nonsurgical trauma to the extrahepatic bile ducts. South Med J. 1969;62:1323–6.

    Article  PubMed  CAS  Google Scholar 

  16. Sheldon GF, Lim RC, Yee ES, Petersen SR. Management of injuries to the porta hepatis. Ann Surg. 1985;202:539–45.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. Fletcher WS. Nonpenetrating trauma to the gallbladder and extrahepatic bile ducts. Surg Clin North Am. 1972;52:711–7.

    PubMed  CAS  Google Scholar 

  18. Carmichael DH. Avulsion of the common bile duct by blunt trauma. South Med J. 1980;73:166–8.

    Article  PubMed  CAS  Google Scholar 

  19. Fish JC, Johnson GL. Rupture of duodenum following blunt trauma: report of a case with avulsion of papilla of Vater. Ann Surg. 1965;162:917–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  20. Cohn Jr I, Cotlar AM, Atik M, Lumpkin WM, Hudson TL, Wernette GJ. Bile peritonitis. Ann Surg. 1960;152:827–35.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mason LB, Sidbury JB, Guiang S. Rupture of the extrahepatic bile ducts from nonpenetrating trauma. Ann Surg. 1954;140:234–41.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Root HD, Keizer PJ, Perry Jr JF. Peritoneal trauma, experimental and clinical studies. Surgery. 1967;62:679–86.

    PubMed  CAS  Google Scholar 

  23. Abou-Mourad NN, Rogers LS. Extrahepatic biliary steering-wheel trauma simulating pancreatic carcinoma – a dilemma in management. J Trauma. 1980;20:180–2.

    Article  PubMed  CAS  Google Scholar 

  24. Wangensteen OH. On the significance of the escape of sterile bile into the peritoneal cavity. Ann Surg. 1926;84:691–702.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  25. Jones KB, Thomas E. Traumatic rupture of the hepatic duct demonstrated by endoscopic retrograde cholangiography. J Trauma. 1985;25:448–9.

    Article  PubMed  CAS  Google Scholar 

  26. Thomson SR, Bade PG. Penetrating bile duct trauma. Injury. 1989;20:215–6.

    Article  PubMed  CAS  Google Scholar 

  27. Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63:805–13.

    Article  PubMed  Google Scholar 

  28. Cotton BA, Gunter OL, Isbell J, Au BK, Robertson AM, Morris JA, et al. Damage control hematology: the impact of a trauma exsanguination protocol on survival and blood product utilization. J Trauma. 2008;64:1177–83.

    Article  PubMed  Google Scholar 

  29. Rotondo MF, Schwab CW, McGonigal MD, Phillips III GR, Fruchterman TM, Kauder DR, et al. “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35:375–82.

    Article  PubMed  CAS  Google Scholar 

  30. Sandblom P, Tabrizian M, Rigo M, Fluckiger A. Repair of common bile duct defects using the gallbladder or cystic duct as a pedicled graft. Surg Gynecol Obstet. 1975;140:425–32.

    PubMed  CAS  Google Scholar 

  31. Rutledge RH. Methods of repair of noncircumferential bile duct defects. Surgery. 1983;93:333–42.

    PubMed  CAS  Google Scholar 

  32. Lucas CE, Walt AJ. Analysis of randomized biliary drainage for liver trauma in 189 patients. J Trauma. 1972;12:925–30.

    Article  PubMed  CAS  Google Scholar 

  33. Northover JMA, Terblanche J. A new look at the arterial supply of the bile duct in man and its surgical implications. Br J Surg. 1979;66:379–84.

    Article  PubMed  CAS  Google Scholar 

  34. Donald JW, Donald JG. Complete severance of the common bile duct due to nonpenetrating trauma. Ann Surg. 1958;148:855–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  35. Dobbie Jr RP, Stormo AC. Complete transection of the common bile duct: the sole sequela of blunt abdominal trauma. J Trauma. 1968;8:9–18.

    Article  PubMed  Google Scholar 

  36. Williams GR. Experiences with surgical reconstruction of the hepatic ducts. Ann Surg. 1974;179:540–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  37. Diethrich EB, Beall Jr AC, Jordan Jr GL, DeBakey ME. Traumatic injuries to the extrahepatic biliary tract. Am J Surg. 1980;112:756–9.

    Article  Google Scholar 

  38. Longmire Jr WP. Early management of injury to the extrahepatic biliary tract. JAMA. 1966;195:623–5.

    Article  PubMed  Google Scholar 

  39. Bengtsson HJ, Broomé AEA, Rimér V. Repair of bile duct defect with full-thickness vascularized jejunal patch. World J Surg. 1986;10:510–5.

    Article  PubMed  CAS  Google Scholar 

  40. Sanchez RM, Halsted GO, Trivelde RR. Common bile duct stricture repair with serosal onlay technic. Am J Surg. 1978;135:258–9.

    Article  PubMed  CAS  Google Scholar 

  41. Senning A. Correction of common bile duct stricture by onlay patch of duodenum. World J Surg. 1979;3:775–9.

    Article  PubMed  CAS  Google Scholar 

  42. Michie W, Gunn A. Bile duct injuries. A new suggestion for their repair. Br J Surg. 1964;51:96–100.

    Article  PubMed  CAS  Google Scholar 

  43. Monk Jr JS, Church JS, Agarwal N. Repair of a traumatic noncircumferential hepatic bile duct defect using a vein patch: case report. J Trauma. 1991;31:1555–7.

    Article  PubMed  Google Scholar 

  44. Belzer FO, Watts JR, Ross HB, Dunphy JE. Auto-reconstruction of the common bile duct after venous patch graft. Ann Surg. 1965;162:346–55.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  45. Cushieri A, Baker PR, Anderson RJL, Holley MP. Total and subtotal replacement of the common bile duct: effect of transhepatic silicone tube stenting. Gut. 1982;24:756–60.

    Article  Google Scholar 

  46. Hartung H, Kirchner R, Baba N, Waldmann D, Strecker EP. Histologic laboratory and x-ray findings after repair of the common bile duct with a Teflon graft. World J Surg. 1978;2:639–42.

    Article  PubMed  CAS  Google Scholar 

  47. Thomas JP, Metropol HJ, Myers RT. Teflon patch graft for reconstruction of the extrahepatic bile ducts. Ann Surg. 1964;160:967–70.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  48. Rydell Jr WB. Complete transection of the common bile duct due to blunt abdominal trauma. Arch Surg. 1970;100:724–8.

    PubMed  Google Scholar 

  49. Waddell WR, Grover FL. The gallbladder as a conduit between the liver and intestine. Surgery. 1973;74:524–9.

    PubMed  CAS  Google Scholar 

  50. Sarr MG, Cameron JL. Surgical management of unresectable carcinoma of the pancreas. Surgery. 1982;91:123–33.

    PubMed  CAS  Google Scholar 

  51. Posner MC, Moore EE. Extrahepatic biliary tract injury: operative management plan. J Trauma. 1985;25:833–7.

    Article  PubMed  CAS  Google Scholar 

  52. Voyles CR, Blumgart LH. A technique for the construction of high biliary-enteric anastomoses. Surg Gynecol Obstet. 1982;154:885–7.

    PubMed  CAS  Google Scholar 

  53. Blumgart LH. Hilar and intrahepatic biliary enteric anastomosis. Surg Clin North Am. 1994;74:845–63.

    PubMed  CAS  Google Scholar 

  54. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 2005;180:101–25.

    Google Scholar 

  55. Smith R. Hepaticojejunostomy with transhepatic intubation. Br J Surg. 1964;51:186–94.

    Article  PubMed  CAS  Google Scholar 

  56. McFadden PM, Tanner G, Kitahama A. Traumatic hepatic duct injury. New approach to surgical management. Am J Surg. 1980;139:268–71.

    Article  PubMed  CAS  Google Scholar 

  57. Mercado MA, Dominguez I. Classification and management of bile duct injuries. World J Gastrointest Surg. 2011;3:43–8.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Wu YV, Linehan DC. Bile duct injuries in the era of laparoscopic cholecystectomies. Surg Clin North Am. 2010;90:787–802.

    Article  PubMed  Google Scholar 

  59. Perera MTPR, Silva MA, Hegab B, Muralidharan V, Bramhall SR, Mayer AD, et al. Specialist early and immediate repair of post-laparoscopic cholecystectomy bile duct injures is associated with an improved long-term outcome. Ann Surg. 2011;253:553–60.

    Article  PubMed  Google Scholar 

  60. Flint LM. Discussion of Ivatury RR, Rohman M, Nallathambi M, Rao PM, Gunduz Y, Stahl WM. The morbidity of injuries of the extra-hepatic biliary system. J Trauma. 1985;25:967–73.

    Google Scholar 

  61. Feliciano DV, Mattox KL, Jordan Jr GL, Burch JM, Bitondo CG, Cruse PA. Management of 1000 consecutive cases of hepatic trauma (1979–1984). Ann Surg. 1986;204:438–45.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  62. Feliciano DV, Martin TD, Cruse PA, Graham JM, Burch JM, Mattox KL, et al. Management of combined pancreatoduodenal injuries. Ann Surg. 1987;250:673–80.

    Article  Google Scholar 

  63. Parkinson SW, Wisniewski ZS. Avulsion of the ampulla of Vater: an isolated injury following blunt abdominal trauma. Aust N Z J Surg. 1978;48:562–4.

    PubMed  CAS  Google Scholar 

  64. Navarrete C, Gobelet JM. Treatment of common bile duct injuries after surgery. Gastrointest Endosc Clin N Am. 2012;22:539–53.

    Article  PubMed  Google Scholar 

  65. Pitt HA, Sherman S, Johnson MS, Hollenbeck AN, Lee J, Daum MR, et al. Improved outcomes of bile duct injuries in the 21st century. Ann Surg. 2013;258:490–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Indiana University Medical Center, 545 Barnhill Drive, EH 509, Indianapolis, IN, 46202, USA

    David V. Feliciano MD

Authors
  1. David V. Feliciano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David V. Feliciano MD .

Editor information

Editors and Affiliations

  1. Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA

    Rao R. Ivatury

Additional information

Chapter adapted from Feliciano DV. Biliary injuries as a result of blunt and penetrating trauma. Surg Clin N Am. 1994; 897–907.

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Feliciano, D.V. (2015). Extrahepatic Biliary System. In: Ivatury, R. (eds) Operative Techniques for Severe Liver Injury. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1200-1_15

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1200-1_15

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1199-8

  • Online ISBN: 978-1-4939-1200-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation