Biliary stricture after blunt abdominal trauma is extremely rare. Therefore, no definitive treatment has been established. Endoscopic management of traumatic biliary stricture, which is less invasive than laparotomy and transhepatic treatment, has been reported for only 7 patients in Japan. We report a case treated endoscopically and review this entity.
A 42-year-old male was referred to our hospital after suffering full impact with a 100-kg iron plate in his right upper quadrant. CT revealed III a type laceration in the left hepatic lobe. Liver enzyme elevation was relieved naturally, but deteriorated again on the 12th day. He was diagnosed with traumatic stricture of the lower bile duct by MRCP and CT. Endoscopic biliary drainage with 7Frx9cm double pigtail plastic stent was performed, which was kept in place for 6 months. During a follow-up period of 3 years, there has been no recurrence of liver dysfunction.
A 69-year-old male was taken to a local hospital for blunt trauma to his knee. In the ER, his right anterior and posterior tibial arteries were pulseless. A CT scan revealed severe stenosis in his right popliteal artery. He was transferred to our hospital for possible arterial reconstruction. On arrival at our hospital, Doppler ultrasound showed dissection of the popliteal artery with thrombosed false lumen. Angiogram of his right lower extremity showed stenosis of his popliteal artery with no perfusion delay. Because the blood flow to his right foot was recovering with time, conservative treatment was chosen and he was put under close observation. After a week, Doppler ultrasound showed shrinkage of the false lumen with no sign of stenosis. His anterior tibial arteries became palpable. The patient was discharged after 4 months with good blood flow to his right foot.
A 65-year-old non-diabetic woman sustained injuries in a traffic accident. On arrival at our hospital, she was fully conscious. There was right-sided blepharoptosis, and on passive opening of the eyes, the right eye was abducted, with adductor paralysis. The pupils were 5 mm (right) and 3 mm (left) in size ; the left pupil showed normal light reflex, while the right did not react to direct/indirect light. Head CT/MRI revealed no abnormalities. A diagnosis of isolated oculomotor nerve palsy associated with mild head injury was made, and conservative treatment was selected. By 1 year after the injury, the patient became capable of unassisted opening of the right eye and unimpaired adduction, although the upward and downward movements remained impaired. The pupils became 4 mm (right) and 3 mm (left) in size. Traumatic isolated oculomotor nerve palsy associated with mild head injury without intracranial injury shows the potential for improvement of the eye movements to the extent that the patient can carry out his/her normal daily living activities.