الفهرس 
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Abstract
Injuries of the biliary tract after blunt abdominal trauma is relatively uncommon, especially those of the extrahepatic biliary tract which are rare. TBIs are associated with high morbidity because of their complex and subtle presentation which may be delayed up to one month after trauma, so that the diagnosis is difficult and need higher level of suspicion.
Biliary tract injuries after blunt abdominal trauma may involve 1) Intrahepatic bile ducts mostly occur as a sequalae of liver parenchymal lacerations, 2) Extrahepatic bile ducts occurs mostly at points of anatomic fixation and may be associated with intrahepatic injury. 3) Gall bladder injury which is the most common location of injury according to literature, and gall bladder distention is an important predisposing factor for its injury by blunt trauma. The injury may occur due to torsion, shearing, or compression forces.
The aim of this work was to describe the different patterns of presentation, modalities of diagnosis, the different techniques of management, and the possible risk factors for the cases of biliary injuries after blunt abdominal trauma at National Liver Institute, Menoufia University in the period from 2010 to December 2017.
40 patients who sustained blunt abdominal trauma were included in our study. They were 32 males and 8 females, and 25 patients belong to Pediatric age group. Road traffic accident crush trauma to the upper abdomen was the most common mechanism of injury and Grade III was the most common liver injury grading. The mean ISS was 16.8 ±8.5 SD.
They were classified according to the presence of biliary injuries into two groups. The group with biliary injuries included 21 patients; with different presentation including bile leak (n=19), bile duct stricture (n=1) and hemobilia (n=1).
SUMMARY
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Our hospital is a tertiary center for HPB surgery so, all patients were initially treated in a trauma center and some of them received maneuvers before referral, the mean interval between the traumatic injury and admission to our department was 9.5 days (range 1 to 60days), and late referral led to more complications and prolonged hospital stay.
Minor bile leak was managed with drainage of the bile via percutaneous pigtail or peri-hepatic drains inserted at damage control surgery except in one patient who underwent endoscopic stenting via ERCP, While Major bile leak was managed via percutaneous drainage in combination with endoscopic decompression and stenting in six cases.
Operative management included; 1) cholecystectomy for isolated perforated Gall bladder, 2) Exteriorization of bile creating controlled external fistula and IOC to identify site of injury in three patients, 3) surgical debridement of lacerated part and closure of suspected small bile ducts (n=5), and 4) Roux-en-Y hepaticojejunostomy was done for five cases that complicated with biliary stricture with un remarkable follow up course.
Regarding to cases with late complications; 1) Hemobilia and RHA pseudoaneurysm was managed with selective TAE. 2) Choledochogastric fistula, distal CBD stricture & cholangitis were managed with endoscopic stenting via ERCP after PTD drainage. 3) Broncho-biliary fistula was managed