Gunshot injuries of the extrahepatic biliary ducts

Objective: To assess our management of gunshot injuries of the extrahepatic biliary ducts. Design: Retrospective study. Setting: Urban teaching hospital, South Africa. Subjects: 17 patients who were found to have gunshot injuries of the extrah epatic bile ducts, January 1993-June 1998. Interventions: Packing and damage control, staged repair, or definitive rep air. Main outcome measures: Morbidity and mortality: Three of the 17 died intrao peratively or postoperatively from causes unrelated to the biliary injury. Of the 14 survivors, 3 were managed initially with packing and damage contr ol, 7 by staged repair, and 4 by definitive biliary repair. Eleven patients had a Roux-en-Y biliary jejunostomy, of whom I developed a late biliary st ricture related to a postoperative anastomotic leak. End-to-end anastomosis of the bile duct was done for 2 patients and they both developed late bili ary strictures. Ligation of the injured duct and cholecystojejunostomy was done for I patient. Conclusion: Roux-en-Y biliary-jejunal anastomosis is appropriate in the tre atment of gunshot injuries of the extrahepatic biliary ducts as there is al ways a degree of tissue loss and some debridement is required, making it di fficult to do a tension-free anastomosis.