Bile duct rupture

Introduction Bile duct rupture refers to the complete or partial defect of the damaged bile duct, or it is only squeezed or sewed by the vascular clamp to cause inflammation and fibrosis of the bile leakage, and finally cause bile duct stenosis or occlusion. Bile duct fracture is common in the scarring of the bile duct caused by bile duct injury, that is, benign biliary stricture.

Cause

Bile duct rupture can be caused by iatrogenic injury, abdominal trauma and bile duct stones, infection. Due to repeated inflammation and bile salt stimulation, the affected bile duct leads to fibrous tissue hyperplasia, thickened wall, narrowed bile duct lumen, and pathological and clinical manifestations of biliary obstruction infection.

an examination

Related inspection

Choledochoscopic T-tube angiography combined with bilirubin (SDB, DBIL) oral cholangiography

(1) History and symptoms

Have a history of biliary tract, upper abdominal surgery (trauma), or a history of recurrent cholangitis.

1 intraoperative (injury) obstructive jaundice within 24 hours, or a large amount of bile overflowing in the drainage port, or asymptomatic after surgery (injury), intermittent epigastric dull pain, chills and fever, jaundice, after several weeks to several years The stool is gray and so on.

2 Charcot triad may be present in an acute attack.

3 chronic patients have long-term jaundice, irregular heat type, jaundice deepened after fever, biliary cirrhosis. Or have cholangitis without jaundice. In severe cases, the disease develops rapidly and rapidly deteriorates, resulting in ACST and sepsis.

(two) signs

1 upper abdominal tenderness during the attack.

2 jaundice.

3 hepatomegaly, tenderness. X-ray angiography of benign biliary stricture.

4 can have signs of portal hypertension and so on.

(3) Auxiliary inspection

1 The number of white blood cells and neutrophils increased, and the test showed obstructive jaundice. The liver function was severely damaged. The ratio of white and globulin was inverted, and blood culture was positive.

2 retrograde cholangiography, PTC, ERCP, can show the location, shape and extent of the stenosis. The bile duct is not developed and the bile duct stenosis cannot be excluded. Sometimes venous cholangiography can also show lesions of the bile duct.

Type 3B ultrasound can show the sonogram of the proximal biliary dilatation, or (and) stones. Intrabiliary ultrasound (IDUS) has special value in the diagnosis of bile duct stenosis. Through the characteristics of different pathological images of bile duct stenosis, benign and malignant lesions of bile duct can be identified.

4MRCP can correctly diagnose the bile duct stenosis after liver transplantation, but compared with ERCP, the details of the lesions are not clear enough, and the degree of stenosis is often exaggerated.

Differential diagnosis

Differential diagnosis of bile duct fracture:

1. Cholecystitis: Cholecystitis is a common disease of the gallbladder caused by bacterial infection or chemical stimulation (change of bile composition). In abdominal surgery, the incidence rate is second only to appendicitis. This disease is more common in middle-aged people aged 35-55 years. The incidence of females is more than that of males, especially in obese women with multiple pregnancies.

2. Cholangitis: biliary tract inflammation is mainly called cholangitis (cholangitis), and cholecystitis is called cholecystitis. The two often occur at the same time, and the etiology, pathogenesis and pathological changes are almost the same, mostly caused by infection of bacteria (mainly Escherichia coli, E. coli and Staphylococcus) on the basis of cholestasis. Bacteria can reach the biliary tract through the lymphatic or bloodstream, or retrograde from the intestine through the duodenal papilla into the biliary tract. In the future, it is more common in China. Can be divided into acute and chronic types.

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