gallbladder trauma due to car accident signs

Gallbladder trauma due to car accident signs full#
Gallbladder trauma due to car accident signs free#

Central intrahepatic biliary duct injuries occur when the trauma affects biliary ducts within 5 cm from the biliary duct bifurcation. Schematic representation of the anatomical classification of intrahepatic biliary duct injuries. In recent years, because of the growing adoption of nonsurgical approaches to the initial treatment of abdominal traumas, this group of patients has increased significantly. These patients usually develop biliary strictures conditioning dilation of the proximal biliary tree with recurrent episodes of cholangitis or obstructive jaundice. Finally, a relatively small proportion of patients presents with late complications, often several months or years after their original trauma. Other diagnostic modalities that can help in the differential diagnosis are hydroxy iminodiacetic acid (HIDA) scan, magnetic resonance cholangiography (MRCP), and endoscopic retrograde cholangiography (ERCP). The presence of elevated concentrations of amylase and bilirubin in the aspirate confirms the occurrence of a bile duct injury or intestinal perforation that will require surgical intervention.

Gallbladder trauma due to car accident signs free#

Therefore, when indicated percutaneous drainage or peritoneal lavage is helpful to characterize the nature of the abdominal free fluid. Radiologically, it is quite difficult to distinguish between blood and other types of fluids. In these cases, cross-sectional imaging studies often show the presence of free intra-abdominal fluid. The second one is diagnosis within the first week and includes 50% of patients with blunt traumas who present with hemodynamic stability and absence of peritoneal signs at the time of presentation in the emergency room. Patients with immediate diagnosis represent a challenging group as they require complex surgical interventions because they often have multiple other injuries. The first one is immediate identification during DCS. There are three main diagnostic patterns of traumatic bile duct injuries. Injuries to the extrahepatic bile ducts are particularly rare and make up no more than 30% of biliary injuries, the vast majority being due to penetrating trauma. Also, when patients suffer damage to vascular structures of the hepatoduodenal ligament, most of the times they do not survive the accident and are pronounced dead before arrival to the emergency department. In patients affected by blunt trauma, the portal vein and hepatic artery are not usually injured because these structures are longer and more elastic than the main bile duct. Moreover, in the proximity to the sphincter of Oddi there is already a physiologic elevation of the intraluminal pressure that is suddenly increased by the traumatic event causing disruption of the bile duct wall in this area. The most convincing is that blunt forces to the abdomen push the liver upward stretching the hepatoduodenal ligament to the point of disruption at the bile duct bifurcation. Theories to explain this phenomenon are several. In patients with injuries of the extrahepatic bile duct, the most frequent location is in the proximity of the hepatic hilum or within the head of the pancreas. Eighty-five percent of patients diagnosed with extrahepatic biliary traumas suffer injuries of the gallbladder, whereas involvement of the main bile duct alone occurs only in 15% of the cases.

Gallbladder trauma due to car accident signs full#

Most of the bile duct injuries from traumas are associated with damage to the liver and present with a spectrum of conditions ranging from full transections or partial lacerations, to simple contusions and wall hematomas. In this chapter, we will focus our attention only on traumatic bile duct injuries. Iatrogenic bile duct injuries have been extensively covered in many other papers. On the other hand, bile duct lesions due to blunt traumas are predominantly caused by traffic accidents (compression by safety belt or airbag), falls, kicks, or work accidents. Among all patients who experience traumatic bile duct injuries, 80–90% are victims of penetrating traumas from stab or gunshot wounds. Therefore, most of the patients are diagnosed when they undergo early explorative laparotomy or when they develop late complications. The diagnosis of non-iatrogenic traumatic bile duct injuries is challenging as current cross-sectional imaging tests are not very specific. Accidental traumas are responsible only for 1–5% of the total number of biliary injuries. The vast majority of bile duct injuries is iatrogenic and occurs during abdominal surgeries or other interventions such as endoscopic or percutaneous cannulation of the biliary tree.