A Case of Hepatic Arterial Injury with Common Bile Duct Stricture due to Steering Wheel Injury

Nobuya Kitamura, Yoshikazu Yamamoto, Masahiro Tomoe, Kazunori Otsuki, Tatsuoki Maruyama, Yukio Seki

Department of Surgery, Kawatetsu Chiba Hospital

A 57-year-old man involved in an automobile accident sustained a steering wheel injury to the upper abdomen. The preoperative diagnosis was intraabdominal hemorrhage and hepatic blunt injury. Opening the abdomen, we found that the hepatic artery was injured at two sites, and these were surgically repaired. The common bile duct was found to have been exposed by trauma. However, no leakage was noticed by cholangiography. The postoperative course was uneventful, even though angiography on the 17th postoperative day suggested that the gastroduodenal artery and right gastric artery had been separated from the common hepatic artery and proper hepatic artery. However, two months later, he developed hyperpyrexia and his liver enzyme level increased. He was rehospitalized. Middle common bile duct stenosis was diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) and hepatobiliary scintigraphy. He was treated conservatively and recovered. However, following his discharge, jaundice had appeared and he underwent choledochoduodenostomy seven months after the first operation. He has remained well since his discharge.

Key words
hepatic arterial injury, bile duct stricture, exposed injury of common bile duct

Reprint requests
Nobuya Kitamura Department of Emergency and Critical Care Medicine, Chiba University School of Medicine
1-8-1 Inohana, Chuou-ku, Chiba, 260 JAPAN

Accepted
April 14, 1993

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