Traumatic Common Bile Duct Injury and Spontaneous Formation of Choledochoduodenal Fistula Managed by Cholecystojejunostomy: A Case Report and Review of Literature.

Traumatic injury to extrahepatic bile duct system is a rare entity. Associated injuries are usually the indication of surgical exploration, and most of the common bile duct (CBD) injuries are diagnosed intraoperatively. Here, we present a case of a 23-year-old boy with a history of road traffic accident. Intraoperatively there was moderate hemoperitoneum with Grade 3 liver laceration, Grade 1 splenic laceration, laceration of anterior wall of stomach, common hepatic artery tear, and complete transaction of CBD. The principle of damage control surgery followed. Stomach laceration repaired and common hepatic artery ligated. Infant feeding tube placed in a proximal portion of transected CBD and distal portion ligated. The patient was discharged on the 45th day with infant feeding tube draining bile. In follow-up OPD tube cholangiogram followed by magnetic resonance cholangiopancreatography done which showed the formation of a choledochoduodenal fistula. Infant feeding tube removed. The patient did well for next 6 months but after that he presented with jaundice which on evaluation found to be due to stricture of choledochoduodenal fistula. The patient underwent elective cholecystojejunostomy. Miraculous spontaneous formation of choledochoduodenal fistula in traumatic CBD injury and management by cholecystojejunostomy is very less reported in the literature.

Innominate Artery Injury: A Catastrophic Complication of Tracheostomy in a Trauma Patient, Operative Procedure Revisited.

Tracheostomy is a routine life-saving operative procedure in the event of airway obstruction especially in faciomaxillary injuries. Bleeding is the most common complications of tracheostomy, innominate artery (IA) of normal width reaching second tracheal ring is very rare, and injury to IA can be a catastrophic complication. We reported a case of 40-year-old male presented with profuse bleeding from oral and nasal cavity following road traffic injury. During tracheostomy, there was a sudden forceful gush of blood coming out of incision site, warning a major vessel injury. Right-sided trap door thoracotomy procedure was performed, and the avulsed right IA was repaired as a life-saving procedure.