Avulsion of common bile duct after blunt abdominal injury: a review of the literature.
Injury to the common bile duct following blunt injury of the abdomen has been reported in 82 previous cases in the literature that we have reviewed. An additional rare case of complete avulsion of the common bile duct at its junction with the pancreas is presented here. Diagnosis has usually been late, peritonitis has commonly been present and 33 per cent of the cases ended fatally. Although diagnosis is often late, there have been many attempts at primary repair; we describe a new technique of delayed repair, which involved intermittent closure of the common duct and was successful in increasing its diameter by the time of the second operation. The initial injury was treated by a cutaneous choledochostomy and 2 jejunostomy tubes, one for decompression and drainage and the other for feeding and replacement of bile. The final repair consisted of a choledochojejunostomy, jejunojejunostomy and T-tube drainage of the common juct. The patient is completely well after two years.