Hepatobiliary Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
BMJ Case Rep. 2021 Feb 4;14(2):e238473. doi: 10.1136/bcr-2020-238473.
A 35-year-old man presented with a gunshot wound to his abdomen via his lower chest. Initial laparotomy did not identify any perforation or contamination. On day 3, a laparotomy under the hepatobiliary service discovered a gastric perforation, two lateral duodenal perforations and a complete transection of the common bile duct, presumably delayed perforation from the shockwave injury produced by the bullet. Contamination and haemodynamic instability precluded immediate reconstruction, and abdominal drains and external biliary drainage were established. High-volume duodenal fistula was managed with slow withdrawal of drains, and inadvertent dislodgement of the biliary drain in an outpatient setting resulted in spontaneous fistulisation of the bile duct to the lateral duodenal wall, with creation of a neo-bile duct. The patient remains well more than 1 year later, without external drainage despite no surgical reconstruction.
一位 35 岁男性因胸部下方的腹部枪伤就诊。初次剖腹探查未发现穿孔或污染。第 3 天行肝胆科剖腹探查发现胃穿孔、两处十二指肠外侧穿孔和胆总管完全横断，推测是子弹冲击波损伤所致的延迟穿孔。污染和血流动力学不稳定妨碍了立即重建，建立了腹部引流和外胆管引流。高容量十二指肠瘘通过缓慢拔出引流管进行管理，在门诊期间胆管引流管意外脱落导致胆管自发瘘至十二指肠外侧壁，形成新胆管。尽管没有手术重建，但患者在 1 年多后仍然状况良好，无需外部引流。
