Case Report
 
Avulsion of the common bile duct and ampulla of Vater after blunt abdominal trauma: Case report and review of the literature
Ayman Zaki Azzam1
1Lecturer of General Surgery, Department of General Surgery, Alexandria University, Alexandria, Egypt.

Article ID: 100001IJHPDAZA2011
doi:10.5348/ijhpd-2011-1-CR-1

Address correspondence to:
Ayman Zaki Azzam
Lecturer of General Surgery, Faculty of Medicine,
Alexandria University,
Alexandria
Egypt

Liver Transplant Surgeon, King Faisal Specialist Hospital and Research Center,
MBC: 72, P.O.Box 3354
Riyaddh 11211
South Arbia
Phone: 966-1-464-7272, ext 39474
Fax: 966-1-442-4817


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How to cite this article:
Azzam AZ. Avulsion of the common bile duct and ampulla of Vater after blunt abdominal trauma: Case report and review of the literature. International Journal of Hepatobiliary and Pancreatic Diseases 2011;1:1-5.


Abstract
Introduction: Extrahepatic bile ducts injuries from blunt abdominal trauma are very rare. The criticality and the difficulty of these injuries are increased by the duodenal wall and the main pancreatic duct injuries. These injuries therefore require special consideration. Diagnosis is always difficult and late and depends on suspicion. Proper management depends on the efficiency of the center, the surgeon and the severity of the injury.
Case Report: A 28-years-old male presented to the emergency unit complaining of falling from motor cycle. The patient was stable. Urgent ultrasound revealed mild intraperitoneal collection. Computerized tomography with contrast showed the same finding with left sided pleural effusion and fracture fifth rib. The patient's condition began to deteriorate with time. Immediate exploration revealed complete avulsion of the CBD from the duodenum. Exteriorization of the CBD to outside the abdomen through the skin was done. The diagnosis of avulsion of the CBD from the sphincter of Oddi was a retrospective diagnosis.
Conclusion: Simple maneuvers can be performed that will not harm the patient and may be of great benefit. In the present case, exteriorization of the CBD to outside by a simple urinary catheter gave us the chance to have an accurate postoperative diagnosis which was not available at the time of the operation. Drainage of the pancreatic and biliary secretions outside the abdomen with no added morbidities also gave us the chance and the time needed to treat other associated complications like respiratory problems.

Keywords Common bile duct, Ampulla of Vater, Blunt abdominal trauma

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Author Contributions:
Ayman Zaki Azzam - Substantial contributions to conception and design, acquisition, analysis and interpretation of data, Drafting the article, revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission:
The corresponding author is the guarantor of submission.
Source of support:
None
Conflict of interest:
Author declares no conflict of interest.
Copyright:
© Ayman Zaki Azzam 2011; This article is distributed the terms of Creative Commons attribution 3.0 License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)