Successful primary endoscopic treatment of suprapancreatic biliary stricture after blunt abdominal trauma

 Commentary

Blunt abdominal trauma is well-known to cause hemobilia, but less commonly results in extrahepatic biliary injury. Fortunately, such biliary injuries now can be diagnosed and therefore treated earlier than previously because of advances in radiologic imaging, eg, CT, magnetic resonance imaging, and MRCP. Most commonly, such injuries are the result, as in this case, of a motor vehicle accident, in which an unrestrained driver has forceful contact with the steering wheel. We are all familiar with aortic injuries in this circumstance, and we should be indebted to Dr. Kibria and associates for teaching us that the bile duct may be similarly damaged. The precise cause of traumatic bile injury and stricture formation probably is multifactorial and related to a tear in the duct with resultant inflammation, ductal compression from a hematoma, or ischemic injury of the duct consequent to interruption of its blood supply. Regardless, prognosis is good, and biliary stenting, if possible, is the appropriate therapy. Of one thing we can be sure, this patient was not autoimmune.

Lawrence J. Brandt, MD

Associate Editor for Focal Points