Complete transection of the left hepatic duct due to blunt abdominal trauma

A 21-year old man was transferred to our hospital after a traffic accident. He had a chief complaint of right upper abdominal pain. Abdominal computed tomography scan at admission showed fluid collection in the abdominal cavity and linear low density area in the hepatic hilus including segment V of the liver. Operative findings revealed a hepatic laceration extending from the boundary between segment IV and segment V to the hepatic hilus, and a completely transection of the left hepatic duct near the caudate lobe without ischemic change and contusion. The bile duct of the caudate lobe communicated with the left hepatic bile duct at the distal portion of the torn wedge, and was not injured. The transected bile duct was primarily repaired with an interrupted end-to-end anastomosis using a retrograde transhepatic bile duct tube (RTBD tube) as stent. Intra- and postoperative cholangiography via the tube revealed no leakage or narrowing. He is in good health of 60 months after surgery. The case illustrates the condition of the transectional wedges for end-to-end anastomosis, and the usefulness of RTBD tube for the anastomosis stent and the diagnosis of the bile leakage after anastomosis.