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HPB Surgery
Volume 2008 (2008), Article ID 259141, 9 pages
Review Article

Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic Hepatic Ductal Injuries due to Blunt Trauma: Diagnostic and Treatment Algorithms

1Department of Surgery, St Luke's Hospital and Health Network, Bethlehem, PA 18015, USA
2Regional Level I Resource Trauma Center, St Luke's Hospital and Health Network, Bethlehem, PA 18015, USA
3University of Pennsylvania Trauma Network, Philadelphia, PA 19104, USA
4STAR/OPUS12 Foundation, 304 Monroe Boulevard, King of Prussia, PA 19406, USA

Received 8 February 2007; Revised 13 April 2007; Accepted 2 August 2007

Academic Editor: Sherif Hanna

Copyright © 2008 Nikhil P. Jaik et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Extrahepatic hepatic ductal injuries (EHDIs) due to blunt abdominal trauma are rare. Given the rarity of these injuries and the insidious onset of symptoms, EHDI are commonly missed during the initial trauma evaluation, making their diagnosis difficult and frequently delayed. Diagnostic modalities useful in the setting of EHDI include computed tomography (CT), abdominal ultrasonography (AUS), nuclear imaging (HIDA scan), and cholangiography. Traditional options in management of EHDI include primary ductal repair with or without a T-tube, biliary-enteric anastomosis, ductal ligation, stenting, and drainage. Simple drainage and biliary decompression is often the most appropriate treatment in unstable patients. More recently, endoscopic retrograde cholangiopancreatography (ERCP) allowed for diagnosis and potential treatment of these injuries via stenting and/or papillotomy. Our review of 53 cases of EHDI reported in the English-language literature has focused on the evolving role of ERCP in diagnosis and treatment of these injuries. Diagnostic and treatment algorithms incorporating ERCP have been designed to help systematize and simplify the management of EHDI. An illustrative case is reported of blunt traumatic injury involving both the extrahepatic portion of the left hepatic duct and its confluence with the right hepatic duct. This injury was successfully diagnosed and treated using ERCP.