Abstract / Summary
Abstract Background Combined pancreatoduodenal injury following blunt abdominal trauma is rare in children, and concomitant extrahepatic bile duct injury is rarer still. Bile duct injury is easily missed on initial imaging and at laparotomy, and typically declares itself only through delayed clinical signs. Case presentation A 21-month-old male child (9.2 kg) sustained blunt abdominal trauma in a road traffic accident, presenting in compensated shock. Contrast-enhanced computed tomography demonstrated multi-organ solid organ injury and pneumoperitoneum. Emergency laparotomy revealed complete transection of the first part of the duodenum and of the pancreatic neck, with an unrecognised hematoma overlying the retro-pancreatic bile duct. Primary duodenal repair, distal pancreatectomy with splenic vein preservation, and feeding jejunostomy were performed. The missed bile duct injury declared itself postoperatively through bile-stained drain output, pale stools, and later progressive jaundice, ultimately requiring cholecystojejunostomy with Roux-en-Y reconstruction six weeks later, as safe dissection of the porta hepatis had not been achieved. Conclusions A traumatic bile duct injury can be safely bridged to delayed reconstruction when bile drains freely through a wide-bore drain without intra-abdominal collection or sepsis, and when enteral bile refeeding is available. Staged management, individualised to the evolving clinical picture, allowed a favourable outcome in this severely injured child.