小动物软组织手术：胆囊与胆道创伤.pdfVIP

48

OtherSurgicalDiseasesoftheGallbladder

andBiliaryTract:Cholecystitis,Neosia,

Infarct,andTrauma

SteveJ.MehlerandPhilippD.Mayhew

Trauma

Traumatothebiliarytractisoneofthemostcommon

causesofsterilebileperitonitisinveterinarypatients

(Watkinsetal.1983;Ludwigetal.1997).Themost

commontraumaticetiologyisbeinghitbyacar,but

gunshotwounds,bitewounds,andotherpenetrating

abdominalwoundsarealsopotentialcauses.Blunt

traumacausesruptureofthecommonbileductmore

frequentlythanruptureofthegallbladder.Themost

commonsiteofcommonbileductruptureisjustdistal

totheentranceofthelasthepaticductbutthedistal

commonbileduct,cysticduct(Figure48-1),andhepatic

ductsmayalsobeinjured(Martinetal.1986;Parchman

Flanders1990;Neer1992;Mehleretal.2004).Thepro-

posedmechanismofbileductrupturefromtrauma

involvesrapidgallbladderemptyingatthetimeofimpact

andasimultaneousshearingforceappliedtoarelatively

shortductsystem.Recognitionofbiliarytracttraumais

frequentlydelayed,sometimesforweeks,andclinical

signsresultfromtheensuingbileperitonitis.Bileperito-Figure48-1Anabdominalultrasoundimageofacatthat

nitisistheusualcauseofdeathincasesoftraumaticsustainedunknowntrauma.Thereisfluidaroundtheoutsideof

extrahepaticbiliarytract(EHBT)rupture;however,thegallbladderwithinthehepaticfossa.Afluidsamplewas

reportedcasesofbileperitonitissecondarytotraumaobtainedwithultrasoundguidanceandwasdeterminedtobe

commonlyhaveanexcellentoutcome(Mehleretal.2004).bile.Thiscathadacysticductruptureatsurgeryandacholecys-

Successfulrepairofrupturedductshasrecentlytectomywasperformed.

beenrepo