1/2. bile duct disruption by blunt trauma.The rarity of bile duct injury secondary to blunt abdominal trauma leads to frequent delays in diagnosis and inappropriate management. An illustrative case is therefore described and 94 reported cases are reviewed. In 53% of patients, operation was delayed more than 24 hours. Early clinical findings of hypovolemia and acute abdomen are related to associated injuries. Late findings are abdominal distention and jaundice due to the biliary injury. early diagnosis is facilitated by diagnostic paracentesis. patients operated on during the first 24 hours after the injury had a statistically higher incidence of bile duct injury distal to the cystic duct (p less than 0.05) and of complete ductal severance (p less than 0.05). The association of location distal to the cystic duct and complete severance was highly significant (p less than 0.001). Management should include biliary exploration. cholangiography using concentrated water-soluble contrast agents may help to find the anatomy of obscure injuries. The choice of surgical repair must be individualized according to the location and the magnitude of the injury.- - - - - - - - - - ranking = 1keywords = ductal (Clic here for more details about this article) |
2/2. Spontaneous perforation of the hepatic duct in adults.BACKGROUND: Nontraumatic perforations of the extrahepatic biliary ductal system are a rare albeit recognized occurrence in the cystic duct, choledochus and main hepatic duct; the latter appears to be the rarest. methods: Recent experience with such a case prompted a thorough review of 26 similar cases previously reported. RESULTS: It appears that obstruction of the biliary tract by gallstones results in raised intraductal pressure leading to dilatation of the biliary tree, subsequent stasis and infection, causing ascending cholangitis and thrombosis of intramural vessels, leading to necrosis and perforation of the duct wall. Most patients present with an acute abdomen and are operated upon. CONCLUSIONS: The goals of operation, which should be tailored to the individual patient, are to stop the bile leak, cure choledocholithiasis and cholangitis and reconstruct the bile duct.- - - - - - - - - - ranking = 2keywords = ductal (Clic here for more details about this article) |