Article Text

Download PDFPDF
Spontaneous fistulisation of the common bile duct after transection by gunshot
  1. Jessica Howard1,2,
  2. Suzanne Di Sano1 and
  3. David Burnett1
  1. 1Hepatobiliary Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia
  2. 2College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
  1. Correspondence to Dr Jessica Howard; jessica.howard{at}health.nsw.gov.au

Abstract

A 35-year-old man presented with a gunshot wound to his abdomen via his lower chest. Initial laparotomy did not identify any perforation or contamination. On day 3, a laparotomy under the hepatobiliary service discovered a gastric perforation, two lateral duodenal perforations and a complete transection of the common bile duct, presumably delayed perforation from the shockwave injury produced by the bullet. Contamination and haemodynamic instability precluded immediate reconstruction, and abdominal drains and external biliary drainage were established. High-volume duodenal fistula was managed with slow withdrawal of drains, and inadvertent dislodgement of the biliary drain in an outpatient setting resulted in spontaneous fistulisation of the bile duct to the lateral duodenal wall, with creation of a neo-bile duct. The patient remains well more than 1 year later, without external drainage despite no surgical reconstruction.

  • gastrointestinal surgery
  • accidents
  • injuries
  • pancreas and biliary tract
  • stomach and duodenum
  • biliary intervention

Statistics from Altmetric.com

Footnotes

  • Contributors JJH performed the background research review, drafted and revised the paper. She is the guarantor. SDS and DB originally participated in patient care, drafted and revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.