Management of obstructive jaundice induced by a retained bullet in the common hepatic duct: A case report

TL;DR

A woman with a bullet lodged in her bile duct for 13 years underwent successful surgery to remove it, resolving her jaundice and cholangitis.

Contribution

This case report presents a rare instance of obstructive jaundice caused by a retained bullet in the common hepatic duct and its successful surgical management.

Findings

A retained bullet in the common hepatic duct can cause obstructive jaundice and cholangitis years after initial injury.

Successful surgical removal of the bullet and primary closure of the bile duct resolved symptoms and restored normal liver function.

Multidisciplinary approaches and meticulous imaging are crucial for diagnosing and managing such rare cases.

Abstract

Traumatic injuries to the extrahepatic bile ducts are rare, with an incidence of 0.4%–0.6% in cholecystectomy procedures among adults, particularly following the introduction of laparoscopic cholecystectomy. Among these, the presence of foreign bodies within the biliary tree is exceptionally rare, with obstructive jaundice caused by a bullet lodged in the common hepatic duct being particularly uncommon. This case report aims to share the diagnostic process and the challenges in managing such a rare condition.

A 41-year-old female with a 13-year history of an accidental gunshot wound, which required an emergency laparotomy, presented to our hospital with symptoms of cholangitis. Endoscopic retrograde cholangiopancreatography was performed, revealing a bullet that caused significant dilation of the proximal bile duct. Exploratory laparoscopy, cholecystectomy, and intraoperative cholangiography confirmed the presence of the bullet. The procedure included a choledochotomy and removal of the bullet, followed by primary closure of the common bile duct using interrupted 4-0 Prolene sutures. The patient was discharged on the 11th postoperative day, and follow-up revealed complete resolution of symptoms and normal liver function.

This case underscores the rarity and complexity of managing extrahepatic bile duct injuries caused by foreign bodies. The delayed presentation of symptoms and the unique diagnostic challenges highlight the necessity for meticulous imaging. The successful surgical intervention in this case highlights the importance of individualized treatment strategies implemented by a multidisciplinary team.

Managing traumatic injuries to the extrahepatic bile ducts requires careful consideration due to their rarity and complexity. The challenges in diagnosis and treatment underscore the necessity of a multidisciplinary approach.

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