Roux loop drainage for post-traumatic biliary cyst.

A 43-year-old manual worker was involved in a heavy-impact roadtraffic accident. He sustained mild concussion and major upper abdominal injuries. On admission to hospital his general condition was poor and he required immediate blood transfusion. Early laparotomy was performed for suspected intra-abdominal bleeding. The abdomen was opened through an upper midline incision, and from this a transverse cut was made to expose the liver. This was found to be severely damaged. A deep laceration extended from the gall-bladder bed to the falciform ligament, along the left triangular ligament, and back down to the porta hepatis. Thus a wedge of liver "with the gall bladder attached to it" was virtually separated from the rest of the organ. This was removed en bloc. The liver was repaired with chromic catgut sutures over oxidized cellulose gauze. The porta hepatis was not explored. A corrugated drain was placed in the right subhepatic space. The immediate postoperative course appeared satisfactory. Eleven days after the accident, however, the patient began complaining of colicky lower abdominal pain. At the time, though his bilirubin level had fallen the alkaline phosphatase level had risen to 33 K.A. units. His condition then remained unchanged until about the eighteenth postoperative day, when the lower lobe of the right lung was found to be collapsed. The liver was relatively more tender. These signs and symptoms gradually resolved and he was discharged home three weeks after the accident. Presentation of Biliary Cyst.-Five weeks after the original injury he was seen again in the outpatient clinic. He appeared noticeably less fit and complained of anorexia, lethargy, and colicky abdominal pain. An ill-defined mass was palpable in the right hypochondrium. Haemoglobin and white cell count were normal. Chest x-ray