Rupture of the common bile duct due to blunt trauma, presenting difficulty in diagnosis

Rupture of the common bile duct because of blunt trauma is extremely rare. Preoperative diagnosis is very difficult because bile causes little peritoneal irritation. We present a case of a 19-year-old young woman with rupture of the common bile duct due to blunt trauma. She arrived at our hospital 1 hour after a car accident. She was diagnosed as pancreatic head injury, and conservative therapy was administered. It was effective, but after starting oral intake 6 days after the injury, she presented with abdominal fullness because of increased ascites. The ascites contained large amounts of bile. Rupture of the common bile duct became apparent, thus, she underwent emergency surgery 13 days after the injury. The common bile duct was ruptured completely at the lower bile duct. We repaired it by choledochojejunostomy. Her postoperative course was uneventful, and she discharged on the 12 days after the surgery. Preoperative drip-infusion-cholangiography-CT was useful for its diagnosis.

Drip infusion cholangiography with CT in cats

Objectives Ultrasonography can detect extrahepatic biliary obstructions. However, visualisation of part of the bile duct using ultrasonography can be technically difficult if there is overlying bowel gas. This study investigated the safety and value of drip infusion cholangiography with computed tomography (DIC-CT) in the visualisation of the bile duct in healthy cats and extrahepatic biliary obstruction in cats with cholelithiasis. Methods DIC-CT was performed in three healthy cats and two cats with cholelithiasis. Meglumine iotroxate was administered by intravenous drip infusion over 30 mins. The attenuation value was measured perpendicular to the lumen by a region of interest covering about 50% of the area of the lumen. Results The bile ducts were visualised successfully with DIC-CT in all healthy cats without any significant adverse events. The attenuation value of the contrast medium was 271 ± 37 HU. In the two cats with cholelithiasis, the presence or absence of extrahepatic biliary obstruction was determined using DIC-CT without any significant adverse events. The attenuation value of cholelithiasis in the cat with an extrahepatic biliary obstruction was 933 ± 119 HU. In the cat with no extrahepatic biliary obstruction, the attenuation value of the contrast medium was 249 ± 53 HU and the attenuation value of cholelithiasis was 167 ± 28 HU. Conclusions and relevance DIC-CT visualises bile ducts and detects obstructive biliary disease without significant adverse events. Therefore, it appears to be a safe procedure for visualisation of the bile duct in cats.