Closed injury of the common bile duct and duodenum.

As injuries in this region are uncommon, most surgeons may expect to treat only a few in a lifetime. The object of this paper is to review the clinical features, and the ancillary aids, which may enable a diagnosis to be made. The infrequency is illustrated by an analysis of 38i cases of ruptured bowel by Rowlands (1923) in which he found only 23 duodenal injuries. Counsellor and McCormack (I935) estimated that duodenal injury occurred in only io per cent. of non-penetrating wounds affecting the bowel. In children the condition is rare, and in 59 intra-abdominal injuries Beckman (1929) did not find a single case. Rupture of the bile ducts alone is exceedingly rare. Milnes Walker (i953) found only 48 cases, to which he added one of his own. A case due to crushing was described by Hicken and Stevenson (1948) and one due to spontaneous rupture with gangrene from an unknown cause has been described by Hart (I95I).