A rare case of hepatic duct injury from blunt abdominal trauma

Background: A 25 year-old male was brought to the emergency room following an apparent suicide attempt by jumping from the fourth floor.
Case Report: Patient had a large abdominal laceration in the right upper quadrant (RUQ). CT scan showed a sub-scapular hematoma of the liver. Due to the repeated episodes of hypotension, a laporotomy was performed and the left hepatic artery was ligated while the ductal injury was managed with a Roux-en-Y left hepatic jejunostomy and stent. Bile leakage was resolved post-operatively by day 5 and the patient was discharged home on day 13 after clearance from psychiatry.
Conclusions: While non-iatrogenic extrahepatic biliary trauma is rare, a high degree of suspicion is essential, especially in cases like the one discussed in this report. Diagnosis can be difficult in patients undergoing observation.

Keywords: gall bladder, laceration, Hepatic Artery - injuries, Jejunostomy