Gunshot injuries of the extrahepatic biliary ducts.

OBJECTIVE

To assess our management of gunshot injuries of the extrahepatic biliary ducts.

DESIGN

Retrospective study.

SETTING

Urban teaching hospital, South Africa.

SUBJECTS: 17 patients who were found to have gunshot injuries of the extrahepatic bile ducts, January 1993-June 1998.

INTERVENTIONS: Packing and damage control, staged repair, or definitive repair.

MAIN OUTCOME MEASURES: Morbidity and mortality: Three of the 17 died intraoperatively or postoperatively from causes unrelated to the biliary injury. Of the 14 survivors, 3 were managed initially with packing and damage control, 7 by staged repair, and 4 by definitive biliary repair. Eleven patients had a Roux-en-Y biliary jejunostomy, of whom 1 developed a late biliary stricture related to a postoperative anastomotic leak. End-to-end anastomosis of the bile duct was done for 2 patients and they both developed late biliary strictures. Ligation of the injured duct and cholecystojejunostomy was done for I patient.

CONCLUSION

Roux-en-Y biliary-jejunal anastomosis is appropriate in the treatment of gunshot injuries of the extrahepatic biliary ducts as there is always a degree of tissue loss and some debridement is required, making it difficult to do a tension-free anastomosis.