Abstract
Appropriate surgical management, selected from various options, is still controversial as the number of accumulated cases of bile duct injury due to blunt abdominal trauma is small. Furthermore, is seems that no single surgical intervention can be justified as the best management for delayed stricture of the common bile duct (CBD). This report describes an illustrative case of blunt trauma leading to delayed stricture of the CBD after immediate celiotomy for liver trauma and minor CBD injury at the intra-pancreatic portion, treated by left lateral segmentectomy and cholecystostomy. An initial postoperative cholangiogram through the cholecystostomy revealed no leakage and good passage of bile into the duodenum. However, follow-up cholangiography demonstrated stricture of the CBD and subsequent complete obstruction on the 31st postoperative day. In this case, the patient was managed conservatively with external bile drainage through the cholecystostomy. Spontaneous reopening of the CBD was evident by the 94th postoperative day. A review of 36 cases of blunt bile duct injury reported in the Japanese literature and our case suggested the possibility that conservative management for delayed stricture of the CBD may result in spontaneous reopening, especially when the stricture developed within 1 month after blunt trauma.
