Spontaneous fistulisation of the common bile duct after transection by gunshot.

Autor:	Howard J; Hepatobiliary Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia jessica.howard@health.nsw.gov.au.; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia., Di Sano S; Hepatobiliary Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia., Burnett D; Hepatobiliary Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia.
Jazyk:	angličtina
Zdroj:	BMJ case reports [BMJ Case Rep] 2021 Feb 04; Vol. 14 (2). Date of Electronic Publication: 2021 Feb 04.
DOI:	10.1136/bcr-2020-238473
Abstrakt:	A 35-year-old man presented with a gunshot wound to his abdomen via his lower chest. Initial laparotomy did not identify any perforation or contamination. On day 3, a laparotomy under the hepatobiliary service discovered a gastric perforation, two lateral duodenal perforations and a complete transection of the common bile duct, presumably delayed perforation from the shockwave injury produced by the bullet. Contamination and haemodynamic instability precluded immediate reconstruction, and abdominal drains and external biliary drainage were established. High-volume duodenal fistula was managed with slow withdrawal of drains, and inadvertent dislodgement of the biliary drain in an outpatient setting resulted in spontaneous fistulisation of the bile duct to the lateral duodenal wall, with creation of a neo-bile duct. The patient remains well more than 1 year later, without external drainage despite no surgical reconstruction. Competing Interests: Competing interests: None declared. (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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