Pericholecystic free fluid, intraluminal or pericholecystic hematoma, or GB wall thickening

• Bile duct injuries
Proximal biliary dilatation with abrupt narrowing of duct at site of bile duct laceration or stricture











IMAGING
General Features
• Location
Postoperative injuries: Common hepatic duct (45-64%) and hepatic hilum (20-33%) most common locations

– Most common injury is common duct transection (common duct mistaken for cystic duct during cholecystectomy)
CT Findings
• Gallbladder injury
Imaging findings may vary depending on degree of injury, and some mild gallbladder contusions may be invisible on imaging
Presence of pericholecystic free fluid, intraluminal or pericholecystic high-density hematoma, or gallbladder wall thickening should raise concern for injury


• Bile duct injuries
Free fluid or loculated collections (bilomas) in right upper quadrant (either intra- or extrahepatic) adjacent to biliary tree

• Helical CT cholangiography (after IV administration of biliary contrast material) to verify and localize bile duct leakage
• Presence of biliary dilatation, configuration of injured bile duct, and ancillary abdominal findings
PATHOLOGY
General Features
• Etiology
Trauma: Can result from blunt or penetrating injuries

– Tend to result from significant trauma with other injuries frequent (especially liver, spleen, and duodenum)
– Most commonly injured site in biliary tree is GB
GB injuries range in severity, including contusion, laceration, perforation, and GB avulsion (separation of GB from GB fossa)
Isolated injury to GB rare due to protection from rib cage and liver, so almost always associated with other significant traumatic injuries


CLINICAL ISSUES
Presentation
• Most common signs/symptoms
Virtually all patients with traumatic bile duct injury have other significant injuries that require attention

Treatment
• Minor bile duct injuries (including many intrahepatic ductal injuries) usually treated conservatively with ERCP stent placement or biliary drainage catheter to divert bile away from site of injury and allow time for healing
• More severe injuries require surgical treatment (usually Roux-en-Y hepaticojejunostomy) after ERCP (or PTC) to assess injury and plan operative repair

































