Bile duct injuries following blunt abdominal trauma are rare complications that may go unnoticed during emergency care. Due to edema and inflammation, these injuries can lead to bile duct obstruction, resulting in dilation of the hepatobiliary system and potential perforations. Such cases are medical emergencies that require prompt and effective management. This case report aims to present a rare case of bile duct stenosis secondary to blunt abdominal trauma, managed using a minimally invasive approach. Outcomes following endoscopic retrograde cholangiopancreatography (ERCP) are also described. A 25-year-old male patient was admitted with progressive right upper quadrant abdominal pain, accompanied by nausea, vomiting, jaundice, choluria, and acholic stools, occurring two months after sustaining blunt abdominal trauma in a car accident. The trauma had resulted in liver and pancreatic injuries, which were managed conservatively. Imaging revealed bile duct dilation and an abrupt transition in the caliber of its distal third, suggestive of biliary injury. Due to obstructive jaundice, the patient underwent ERCP, which confirmed significant bile duct stenosis. A biliary sphincterotomy was performed, and a prophylactic pancreatic stent was placed to reduce the risk of post-ERCP pancreatitis. However, the patient subsequently developed acute pancreatitis and hemorrhagic shock. Upper gastrointestinal endoscopy identified bleeding and sclerosis of the duodenal papilla. Endoscopic hemostasis using clips, bile duct drainage, and placement of a biliary prosthesis were performed, resulting in clinical improvement. Seventeen days later, the patient developed hospital-acquired pneumonia with pleural effusion and underwent thoracostomy with closed pleural drainage, along with antibiotic therapy using piperacillin and tazobactam, which resolved the condition. The patient remains under outpatient follow-up, undergoing serial dilation of the bile duct. Bile duct strictures are rare complications of blunt abdominal trauma and can have serious consequences. Therefore, it is essential for healthcare teams to remain vigilant for potential biliary tract involvement in post-traumatic patients, maintaining a high index of suspicion in the presence of clinical deterioration or symptoms of biliary obstruction.
Moraes et al. (Tue,) studied this question.