Künt multi-travma olgusunda teþhisi gecikmiþ tam kat ana hepatik kanal yaralanmasýnýn baþarýlý yönetimi

Ekstrahepatik safra yolu yaralanmalarý nadirdir ve çoklu travma hastalarýnda kolayca gözden kaçabilmektedir. Safra yolu yaralanmasý olan hastalar bu konuda özel bir yaklaþým ile tedavi edilmelidirler. Bu yazýda, ana hepatik kanalýn tamamen ayrýþtýðý bir olgu ve tedavi yaklaþýmý tartýþýldý. Stabil olmayan hastalarda hasar kontrol cerrahisi de kullanýlabilmektedir. Otuz iki yaþýnda erkek hasta, acil servise darp nedeniyle oluþan çoklu travma sonucu getirildi. Radyolojik görüntülemede kranyal, nazal, lumbar vertebral ve kostal kýrýklar, sað böbreðe azalmýþ kan akýmý ve perihepatik, perisplenik sývý mevcuttu. Bu safhada acil cerrahi düþünülmeyen hasta nöroþirürji doktorlarý tarafýndan ameliyat edildi. Takiplerinde, ameliyat sonrasý ikinci günde hasta genel cerrahi kliniðine devredildi ve tanýsal laparotomi uygulandý. Ana hepatik kanal tamamen ayrýþmýþtý ve hastanýn hemodinamik olarak stabil olmamasý nedeniyle hastanýn safra yolunun eksternal fistül þeklinde býrakýlmasýna karar verildi. Hasta ameliyat sonrasý 10. gününde taburcu edildi. Hastanýn klinik takiplerine devam edildi ve elektif þekilde roux-n-y hepatikojejunostomi uygulandý. Ekstrahepatik safra yollarý klinik olarak nadir görülmekle birlikte kompleks multitravma hastalarýnda bu konuda þüphelenmek gereklidir. Hasarýn boyutu her hasta için özeldir ve tamir için kullanýlan cerrahi teknik zorlayýcý olabilmektedir

Delayed diagnosis and successful management of completely transected common hepatic duct in a blunt multitrauma patient

Extrahepatic bile duct injuries are very uncommon and easily be missed in multitrauma patients. Patients suffer from bile duct injuries need special approach to this situation. In this report, a case with total transection of common hepatic duct and treatment approach was presented. In unstable patients, damage control surgery can be applied. A 32-year-old male patient was brought to the emergency department after a beating that includes multiple blunt trauma. Radiological screening showed cranial, nasal, lumbar vertebral, and costal bone fractures, decreased blood flow to the right kidney and free perihepatic and perisplenic fluid. Neurosurgeons operated this patient at the day of admission and no plan for laparotomy was made for this patient at that time. Second day postoperatively patient was transferred to the department of surgery and exploratory laparotomy has been made. Common hepatic duct was fully transected and because of the patient’s hemodynamic instability, an external fistula has been made. The patient discharged 10th day postoperatively. The patient was operated after follow-up and a Roux-en-y hepaticojejunostomy has been made. Extrahepatic bile duct injuries are rare and high suspicion is important in complex multitrauma patients. Extent of the injury is unique for every patient and technical aspect of repair can be challenging.