Extra-Hepatic Bile Duct Injury in Blunt Trauma; A Systematic Review

Background Extra-hepatic bile duct injuries (EHBDIs) are a rare consequence of blunt abdominal trauma. The purpose of this study was to establish mechanisms of injury, clinical indicators of EHBDI following blunt trauma (both with investigative modalities and intraoperatively), method and timing of injury detection, and definitive treatment options. Method A Systematic Review was performed to gather data on patients with an extrahepatic bile duct injury secondary to blunt trauma. Three databases (MEDLINE, PubMed, and EMBASE) were searched to 19th July 2018. Results Our systematic review included 51 studies, compromising a study population of 66 patients with EHBDIs sustained from blunt trauma. The three most common injuries included complete transection of the suprapancreatic common bile duct (CBD) (29%, n = 19), complete transection of the intrapancreatic CBD (23%, n = 15) and partial laceration of the left hepatic duct (20%, n = 13). Of the haemodynamically stable group managed non-operatively (n=23), mean timing post injury to diagnosis of EHBDI was 11 days. An EHBDI was recognized at initial laparotomy in 87% (n=13) of hemodynamically stable patients. An EHBDI was recognized at initial laparotomy in 57% (n=8) of hemodynamically unstable patients. Conclusion EHBDIs are a rare yet serious consequence of blunt trauma. To establish a timely diagnosis and limit complications of missed injuries, a heightened awareness is required by the attending surgeon with particular attention to subtle yet important clinical indicators. These vary depending on the haemodynamic stability of the patient and decision to manage injuries conservatively or surgically on presentation. Level of Evidence Level 3 Systematic Review Author for Correspondence: Doctor Ryan Pereira E: ryan.pereira@my.jcu.edu.au T: +61 7 3176 2767: Doctor Tovi Vo E: tovi.vovi@gmail.com T: +61 7 3176 2767: Associate Professor Kellee Slater E: kellee.slater@gov.health.qld.au T: +61 7 3176 2767 Hepatobiliary and Pancreatic Surgery Unit Level 4, Princess Alexandra Hospital 199 Ipswich Road, Woolloongabba, QLD, 4102 All the listed authors agree with the content of the submitted manuscript for publication. None of the authors have received any grants, equipment, and/or pharmaceutical items requiring declaration. There are no potential conflicts of interest. The manuscript has not been published previously and is not under consideration elsewhere. © 2019 Lippincott Williams & Wilkins, Inc.

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