Common Bile Duct Transection Associated with High-Grade Splenic Injury

Introduction: Injuries to the common bile duct (CBD) resulting from blunt trauma are exceedingly rare in children, accounting for less than 1% of abdominal trauma. Moreover, this diagnosis is commonly delayed due to distracting intra-abdominal injuries. Case: A 13-year-old girl presented after a motor vehicle collision with a non-operatively managed grade V splenic laceration and an unstable L2 fracture diagnosed by CT scan. Her hemoglobin remained stable after the posterior repair of the L2 fracture; however, her clinical course was complicated by persistent abdominal distension, jaundice and a prolonged ileus. After paracentesis revealed ascites with elevated bilirubin, a HIDA scan suggested a CBD transaction. This was confirmed by an ERCP. At laparotomy, a transection of the CBD at the superior border of the pancreas was observed and an operative cholecystogram demonstrated stricture of the distal CBD transection site. This injury was repaired via a Roux-en-Y choledochojejunostomy. The patient had an uneventful recovery at 2 month follow-up. Conclusion: Modern imaging can assist in the diagnosis of a rare pediatric CBD transection after blunt trauma, and we report the successful repair of a delayed diagnosis of this condition in the absence of related liver or duodenal injury. Conservative management of high-grade splenic injuries may also delay diagnosis of CBD transections that might otherwise be diagnosed at laparotomy.