Chung Y C, Lee P H, Huang M T, Chang C N
Department of Surgery, Provincial Hsin-Chu Hospital, Taiwan, R.O.C.
J Formos Med Assoc. 1993 Jan;92(1):78-81.
A case of complete transection of the common bile duct due to abdominal blunt injury in a 49-year-old man is presented. The rarity of this injury and its initial presentation as a pancreatic pseudocyst warrant its description. This patient was diagnosed as having bile duct injury following ascites aspiration. Common bile duct transection was documented and a choledochostomy was done. However, bile leaked into the peritoneal cavity one week after the operation. A Roux-en-Y choledochojejunostomy was done successfully in a second operation. Delayed diagnosis is common in these kinds of injuries, but it should be considered when a patient has bile ascites, abdominal distention and jaundice after a blunt abdominal injury. A review of the literature, methods of diagnosis and the technique of surgical repair are described.
本文报告一例49岁男性因腹部钝性损伤导致胆总管完全横断的病例。这种损伤的罕见性及其最初表现为胰腺假性囊肿值得描述。该患者在腹水抽吸后被诊断为胆管损伤。记录了胆总管横断情况并进行了胆总管造口术。然而,术后一周胆汁漏入腹腔。在第二次手术中成功进行了Roux-en-Y胆总管空肠吻合术。这类损伤中延迟诊断很常见,但当患者在腹部钝性损伤后出现胆汁性腹水、腹胀和黄疸时应予以考虑。本文还介绍了文献综述、诊断方法和手术修复技术。