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Case Reports
. 2025 Jun 11;2025(2):62.
doi: 10.5339/qmj.2025.62. eCollection 2025.

Management of obstructive jaundice induced by a retained bullet in the common hepatic duct: A case report

José A Rodriguez Zamboni  1 , Martin J Drago  1 , Lucila Fregonese  1 , Ricardo Reverendo  1 , Luis E Sarotto  1
Affiliations
Case Reports

Management of obstructive jaundice induced by a retained bullet in the common hepatic duct: A case report

José A Rodriguez Zamboni et al. Qatar Med J. .

Abstract

Background: Traumatic injuries to the extrahepatic bile ducts are rare, with an incidence of 0.4%-0.6% in cholecystectomy procedures among adults, particularly following the introduction of laparoscopic cholecystectomy. Among these, the presence of foreign bodies within the biliary tree is exceptionally rare, with obstructive jaundice caused by a bullet lodged in the common hepatic duct being particularly uncommon. This case report aims to share the diagnostic process and the challenges in managing such a rare condition.

Case presentation: A 41-year-old female with a 13-year history of an accidental gunshot wound, which required an emergency laparotomy, presented to our hospital with symptoms of cholangitis. Endoscopic retrograde cholangiopancreatography was performed, revealing a bullet that caused significant dilation of the proximal bile duct. Exploratory laparoscopy, cholecystectomy, and intraoperative cholangiography confirmed the presence of the bullet. The procedure included a choledochotomy and removal of the bullet, followed by primary closure of the common bile duct using interrupted 4-0 Prolene sutures. The patient was discharged on the 11th postoperative day, and follow-up revealed complete resolution of symptoms and normal liver function.

Discussion: This case underscores the rarity and complexity of managing extrahepatic bile duct injuries caused by foreign bodies. The delayed presentation of symptoms and the unique diagnostic challenges highlight the necessity for meticulous imaging. The successful surgical intervention in this case highlights the importance of individualized treatment strategies implemented by a multidisciplinary team.

Conclusion: Managing traumatic injuries to the extrahepatic bile ducts requires careful consideration due to their rarity and complexity. The challenges in diagnosis and treatment underscore the necessity of a multidisciplinary approach.

Keywords: Obstructive jaundice; biliary surgery; bullet injury; common hepatic duct; foreign body.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
ERCP revealing a bullet-shaped foreign body (arrow) in the CBD (star), with significant proximal dilation observed.
Figure 2
Figure 2
An IOC revealed a radiopaque, bullet-shaped object (arrow) located in the middle third of the common hepatic duct (star), with proximal dilation.
Figure 3
Figure 3
Bullet removed from the CBD using transcystic forceps.
Figure 4
Figure 4
Closure of the CBD (star) with interrupted 4-0 Prolene sutures (arrow). L: liver.
See this image and copyright information in PMC

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