Isolated Common Bile Duct Injury Following Blunt Abdominal Trauma: A Case Report

腹部鈍傷後所導致之總膽管單獨損傷：一病例報告

薛承君(Chen-June Seak) ； 陳漢明(Han-Ming Chen) ； 黃集仁(Chip-Jin Ng)

《Journal of Emergency Medicine, Taiwan》 8卷1期 (2006/03) Pp. 23-26

摘要

腹部鈍傷而造成總膽管單獨損傷之病例是相當少見的，由於初期症狀不明顯常會發生延誤診斷，我們提出一名三十八歲男性病患在腹部鈍傷後造成之總膽管單獨損傷病例。起初的腹膜性刺激表現很快就消失了。接踵而至的是一段臨床靜止時期及逐漸的由破裂之膽管所滲出之膽汁形成之黃疸、惡心、嘔吐、厭食、腹痛及逐漸腹脹。開刀剖腹時發現總膽管撕裂傷並且以總膽管切開術及T型成功治療。腹部鈍傷後所造成之單獨膽道損傷經常會發生延誤診斷且在腹部鈍挫傷後之病患若產生黃疸及腹脹就必須加以考慮。本文回顧過去文獻，並就診斷方法及手術技巧加以討論。

關鍵字

總膽管損傷 ； 腹部鈍傷 ； 磁振膽道胰管攝影

並列摘要

We report a case of isolated common bile duct injury due to blunt trauma in a 38-year-old male following a traffic accident. The initial presentation of peritoneal irritation resolved quickly. It was then followed by a quiescent period and insidious development of jaundice, nausea, vomiting, anorexia, abdominal pain and progressive abdominal distension due to biliary ascites. Common bile duct laceration was noted at laparotomy and was successfully treated by choledochotomy and T-tube stent. Delayed diagnosis of isolated biliary injury following blunt trauma is frequently encountered and it should be considered when patients develop jaundice and abdominal distention after a blunt abdominal trauma. A review of the literature and the discussion about methods of diagnosis and technique of surgical intervention are presented.

並列關鍵字

common bile duct injury ； blunt abdominal trauma ； magnetic resonance cholangiopancreatography MRCP