Management

Choledochojejunostomy with Roux limb is the definitive procedure for an injury. This is done with an end-to-side single layer anastomosis and drained with T-tube or through the liver. A 60-70 cm length of jejunum is used and secured to the abdominal wall with an O ring (chimney) to allow for radiologic interventions.

Hepaticojejunostomy can be done if there is insufficient bile duct length. This is frequently the case. Remember that the bile duct blood supply is tenuous and the closer to the liver you take it the better chance for good supply. Intraparenchymal duct anastomosis may be necessary.

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