Rodriguez Zamboni José A, Drago Martin J, Fregonese Lucila, Reverendo Ricardo, Sarotto Luis E
General Surgery Department, Hospital Central de Emergencia y Alta Complejidad de Pilar, Buenos Aires, Argentina *Email:
Qatar Med J. 2025 Jun 11;2025(2):62. doi: 10.5339/qmj.2025.62. eCollection 2025.
Traumatic injuries to the extrahepatic bile ducts are rare, with an incidence of 0.4%-0.6% in cholecystectomy procedures among adults, particularly following the introduction of laparoscopic cholecystectomy. Among these, the presence of foreign bodies within the biliary tree is exceptionally rare, with obstructive jaundice caused by a bullet lodged in the common hepatic duct being particularly uncommon. This case report aims to share the diagnostic process and the challenges in managing such a rare condition.
A 41-year-old female with a 13-year history of an accidental gunshot wound, which required an emergency laparotomy, presented to our hospital with symptoms of cholangitis. Endoscopic retrograde cholangiopancreatography was performed, revealing a bullet that caused significant dilation of the proximal bile duct. Exploratory laparoscopy, cholecystectomy, and intraoperative cholangiography confirmed the presence of the bullet. The procedure included a choledochotomy and removal of the bullet, followed by primary closure of the common bile duct using interrupted 4-0 Prolene sutures. The patient was discharged on the 11th postoperative day, and follow-up revealed complete resolution of symptoms and normal liver function.
This case underscores the rarity and complexity of managing extrahepatic bile duct injuries caused by foreign bodies. The delayed presentation of symptoms and the unique diagnostic challenges highlight the necessity for meticulous imaging. The successful surgical intervention in this case highlights the importance of individualized treatment strategies implemented by a multidisciplinary team.
Managing traumatic injuries to the extrahepatic bile ducts requires careful consideration due to their rarity and complexity. The challenges in diagnosis and treatment underscore the necessity of a multidisciplinary approach.
肝外胆管创伤性损伤较为罕见，在成人胆囊切除术中的发生率为0.4%-0.6%，尤其是在腹腔镜胆囊切除术引入之后。其中，胆道系统内存在异物极为罕见，由 lodged 在肝总管的子弹引起的梗阻性黄疸尤为少见。本病例报告旨在分享诊断过程以及处理这种罕见病症时所面临的挑战。
一名41岁女性，有13年意外枪伤史，曾接受急诊剖腹手术，现因胆管炎症状前来我院就诊。进行了内镜逆行胰胆管造影，发现一枚子弹导致近端胆管明显扩张。 exploratory 腹腔镜检查、胆囊切除术和术中胆管造影证实了子弹的存在。手术包括胆总管切开取子弹，然后用4-0 Prolene间断缝线对胆总管进行一期缝合。患者术后第11天出院，随访显示症状完全缓解且肝功能正常。
本病例强调了处理异物引起的肝外胆管损伤的罕见性和复杂性。症状的延迟出现以及独特的诊断挑战凸显了细致成像的必要性。本病例成功的手术干预突出了多学科团队实施个体化治疗策略的重要性。
由于肝外胆管创伤性损伤的罕见性和复杂性，处理时需要仔细考虑。诊断和治疗方面的挑战凸显了多学科方法的必要性。
