Endoscopic management of a post-gunshot biliary injury in a conflict zone: a case report from Sudan.

Traumatic biliary injuries are rare but serious complications following abdominal trauma, often presenting significant diagnostic and therapeutic challenges, particularly in resource-limited, conflict-affected settings. We report the case of a 31-year-old male soldier who sustained gunshot injuries to the abdomen and left hand during armed conflict. He was hemodynamically unstable on presentation and underwent emergency exploratory surgery, during which liver injury was identified and bleeding controlled. Seven days postoperatively, a biliary fistula developed, confirmed by magnetic resonance cholangiopancreatography (MRCP). The patient was referred for endoscopic management, where endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and biliary stenting was successfully performed. Follow-up ERCP after 6 months showed complete resolution of the biliary fistula, and the stent was safely removed. This case highlights the critical role of ERCP in managing traumatic bile leaks, especially in war zones where surgical interventions may be limited. Endoscopic therapy offers a less invasive and highly effective alternative for treating biliary complications in complex scenarios.