Two Cases of Bile Duct Stricture Secondary to Blunt Abdominal Trauma Treated by Different Therapeutic Modalities.

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  • 治療法の異なる外傷性胆道狭窄の2症例

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Abstract

Traumatic biliary stricture is a relatively rare path ologic condition developing after abdominal trauma. We treated 2 patients with traumatic biliary stricture who differed in the mechanism of injury, organs simultaneously injured, and treatment principles. Patient 1 had steering wheel trauma, with surgery indicated mainly for stricture of the pancreatic duct. However, since biliary stricture developed and was diagnosed preoperatively, choledochoduodenostomy was conducted following Letton and Wilson's procedure, and the patient was discharged 54 days after injury (44 days after onset). Patient 2 underwent emergency laparotomy for duodenal perforation and retroperitoneal bleeding due to seatbelt injury. Biliary stricture developed 14 days postoperatively and was treated by percutaneo-transhepatic cholangiole drainage (PTCD). This patient had to remain hospitalized 95 days after injury (81 days after onset). For traumatic biliary stricture, nonoperative treatment may be the first choice despite onset time and the mechanism of injury, but long hospitalization is difficult to avoid. As in patient 1, when laparotomy is conducted for coexisting injury, diversion of the biliary tract may be useful.

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