COMPLETE TRANSECTION OF THE LEFT HEPATIC DUCT DUE TO BLUNT ABDOMINAL-TRAUMA

A 21-year old man was transferred to our hospital after a traffic acci dent. He had chief complaint of right upper abdominal pain. Abdominal computed tomography scan at admission showed fluid collection in the a bdominal cavity and linear low density area in the hepatic hilus inclu ding segment V of the liver. Operative findings revealed a hepatic lac eration extending from the boundary between segment IV and segment V t o the hepatic hilus, and a completely transection of the left hepatic duct near the caudate lobe without ischemic change and contusion. The bile duct of the caudate lobe communicated with the left hepatic bile duct at the distal portion of the torn wedge, and was not injured. The transected bile duct was primarily repaired with art interrupted end- to-end anastomosis using a retrograde transhepatic bile duct tube (RTB D tube) as stent. Intra- and postoperative cholangiography via the tub e revealed no leakage or narrowing. He is in good health for 60 months after surgery. The case illustrates the condition of the transectiona l wedges for end-to-end anastomosis, and the usefulness of RTBD tube f or the anastomotic stent and the diagnosis of bile leakage after anast omosis.