Lehto M, Vilkki P
Ann Chir Gynaecol. 1985;74(6):296-8.
Injuries to intrahepatic biliary ducts rarely cause severe clinical manifestations in context with blunt abdominal trauma. A case with mild symptoms and signs, but slowly developing bile peritonitis due to posttraumatic intraperitoneal hepatic bile duct fistula is described here. A young girl sustained a blunt contusion on the right lower thoracoabdominal region by the handle bar of a bike. A week after the accident ultrasonography revealed fluid under the liver. The patient showed no signs of peritonitis but had occasional shoulder pain. At laparotomy 200 ml of biliary fluid was drained from the subphrenic space, and excoriation was observed on the upper surface of the liver. A second operation was necessary due to continuous bile leakage via the drain in the subphrenic space and a bile-fistula was demonstrated by contrast x-ray examination. A local resection of the liver was performed and the intrahepatic bile duct fistula closed by a ligature. The postoperative course was then uneventful and the patient was symptomfree on examination six months after the accident.
肝内胆管损伤在钝性腹部创伤时很少引起严重的临床表现。本文描述了一例症状和体征较轻，但因创伤后肝内胆管腹膜内瘘导致胆汁性腹膜炎缓慢发展的病例。一名年轻女孩被自行车车把撞击右下胸腹部区域，造成钝挫伤。事故一周后，超声检查发现肝脏下方有液体。患者没有腹膜炎体征，但偶尔有肩部疼痛。剖腹手术时，从膈下间隙引流了200毫升胆汁液，并观察到肝脏上表面有擦伤。由于膈下间隙引流管持续胆汁漏出，需要进行第二次手术，造影X线检查证实存在胆瘘。对肝脏进行了局部切除，并通过结扎封闭肝内胆管瘘。术后过程顺利，事故六个月后检查时患者无症状。
