{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:53:46Z","timestamp":1777312426580,"version":"3.51.4"},"reference-count":50,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"\n Background:<\/jats:bold>\n Traumatic injuries to the extrahepatic bile ducts are rare, with an incidence of 0.4%\u20130.6% 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.\n <\/jats:p>\n \n Case Presentation:<\/jats:bold>\n 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.\n <\/jats:p>\n \n Discussion:<\/jats:bold>\n 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.\n <\/jats:p>\n \n Conclusion:<\/jats:bold>\n 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.\n <\/jats:p>","DOI":"10.5339\/qmj.2025.62","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T01:30:42Z","timestamp":1751247042000},"source":"Crossref","is-referenced-by-count":0,"title":["Management of obstructive jaundice induced by a retained bullet in the common hepatic duct: A case report"],"prefix":"10.5339","volume":"2025","author":[{"given":"Jos\u00e9 A.","family":"Rodriguez Zamboni","sequence":"first","affiliation":[{"name":"General Surgery Department, Hospital Central de Emergencia y Alta Complejidad de Pilar, Buenos Aires, Argentina*Correspondence: Jos\u00e9 A. Rodriguez Zamboni agustinzamboni@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin J.","family":"Drago","sequence":"additional","affiliation":[{"name":"General Surgery Department, Hospital Central de Emergencia y Alta Complejidad de Pilar, Buenos Aires, Argentina*Correspondence: Jos\u00e9 A. Rodriguez Zamboni agustinzamboni@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucila","family":"Fregonese","sequence":"additional","affiliation":[{"name":"General Surgery Department, Hospital Central de Emergencia y Alta Complejidad de Pilar, Buenos Aires, Argentina*Correspondence: Jos\u00e9 A. Rodriguez Zamboni agustinzamboni@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Reverendo","sequence":"additional","affiliation":[{"name":"General Surgery Department, Hospital Central de Emergencia y Alta Complejidad de Pilar, Buenos Aires, Argentina*Correspondence: Jos\u00e9 A. Rodriguez Zamboni agustinzamboni@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis E.","family":"Sarotto","sequence":"additional","affiliation":[{"name":"General Surgery Department, Hospital Central de Emergencia y Alta Complejidad de Pilar, Buenos Aires, Argentina*Correspondence: Jos\u00e9 A. Rodriguez Zamboni agustinzamboni@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"key":"CIT0001","series-title":"Ann Surg","first-page":"324\u201330","article-title":"Evolution in the management of hepatic trauma: a 25-year perspective","volume":"232","author":"David Richardson\n \nJ","year":"2000;"},{"key":"CIT0002","series-title":"In: Post-cholecystectomy bile duct injury","first-page":"11\u201319","article-title":"Epidemiology of bile duct injury","author":"Kapoor\n \nVK","year":"2020"},{"key":"CIT0003","series-title":"HPB (Oxford)","first-page":"786\u201394","article-title":"Reporting of complications after laparoscopic cholecystectomy: a systematic review","volume":"20","author":"Alexander\n \nHC","year":"2018;"},{"key":"CIT0004","series-title":"Ann Surg","first-page":"143\u201350","article-title":"Long-term impact of bile duct injury on morbidity, mortality, quality of life, and work related limitations","volume":"268","author":"Booij\n \nKAC","year":"2018;"},{"key":"CIT0005","series-title":"J Am Coll Surg","first-page":"568\u201376.e561","article-title":"Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes","volume":"226","author":"Fong\n \nZV","year":"2018;"},{"key":"CIT0006","series-title":"Surg Endosc","first-page":"4294\u20139","article-title":"Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy","volume":"30","author":"Halbert\n \nC","year":"2016;"},{"key":"CIT0007","series-title":"Abdom Imaging","first-page":"748\u20139","article-title":"Biliary obstruction secondary to combat-related foreign bodies: report of two cases","volume":"30","author":"Kamona\n \nA","year":"2005;"},{"key":"CIT0008","series-title":"Surg Endosc","first-page":"3079\u201384","article-title":"Bile duct injuries: a contemporary survey of surgeon attitudes and experiences","volume":"34","author":"Fletcher\n \nR","year":"2019;"},{"key":"CIT0009","series-title":"World J Gastrointest Surg","first-page":"43\u20138","article-title":"Classification and management of bile duct injuries","volume":"3","author":"Mercado\n \nMA","year":"2011;"},{"key":"CIT0010","series-title":"Chirurg","first-page":"681\u20134","article-title":"Neue WSES-AAST-Leitlinie zum Trauma des Duodenums, des Pankreas und der extrahepatischen Galleng\u00e4nge \u2013 Zusammenfassung und Kommentar [New WSES-AAST guideline on duodeno-pancreatic and extrahepatic biliary tree trauma-summary and comments]","volume":"91","author":"Hecker\n \nA","year":"2020;"},{"key":"CIT0011","series-title":"J Pediatr Surg","first-page":"345\u20138","article-title":"Treatment and outcome of traumatic biliary injuries in children","volume":"49","author":"Soukup\n \nES","year":"2014;"},{"key":"CIT0012","series-title":"J Trauma Acute Care Surg","first-page":"1620\u20135","article-title":"Management of blunt and penetrating biliary tract trauma","volume":"72","author":"Thomson\n \nBN","year":"2012;"},{"key":"CIT0013","series-title":"Int J Surg Case Rep","first-page":"276\u20139","article-title":"Late cholestatic syndrome due to previous perforating trauma: case report","volume":"61","author":"De Macedo\n \nFPPC","year":"2019;"},{"key":"CIT0014","series-title":"J Trauma","first-page":"157\u20138","article-title":"Delayed presentation of a penetrating biliary tract injury in a child","volume":"40","author":"Rescorla\n \nFJ","year":"1996;"},{"key":"CIT0015","series-title":"Clin Radiol","first-page":"334\u20135","article-title":"Bullet in the common hepatic duct: a cause of obstructive jaundice","volume":"58","author":"Maheshwari\n \nM","year":"2003;"},{"key":"CIT0016","series-title":"Gastrointest Endosc","first-page":"194\u20135","article-title":"Endoscopic removal by ERCP of a foreign body (bullet) in the common bile duct","volume":"94","author":"Calderon\n \nAJ","year":"2021;"},{"key":"CIT0017","series-title":"J Coll Physicians Surg Pak","first-page":"232\u20133","article-title":"Delayed obstructive jaundice secondary to bullet in common hepatic duct","volume":"17","author":"Hussain\n \nSM","year":"2007;"},{"key":"CIT0018","series-title":"Gastrointest Endosc","first-page":"147\u201350","article-title":"Pancreatic foreign body: ingested toothpick as a cause of pancreatitis and hemorrhage","volume":"59","author":"Kim\n \nKH","year":"2004;"},{"key":"CIT0019","series-title":"Neurol Res","first-page":"475\u201380","article-title":"Incidence of intracranial bullet fragment migration","volume":"21","author":"Rapp\n \nLG","year":"1999;"},{"key":"CIT0020","series-title":"Mil Med","first-page":"e107\u201313","article-title":"Extra-articular retained missiles; Is surveillance of lead levels needed?","volume":"183","author":"Nickel\n \nWN","year":"2018;"},{"key":"CIT0021","series-title":"Urol Case Rep","first-page":"101016","article-title":"Migrated bullet in the bladder presenting 18 years after a gunshot wound","volume":"28","author":"Marantidis\n \nJ","year":"2019;"},{"key":"CIT0022","series-title":"In: StatPearls","article-title":"Bile duct injury","author":"Moghul\n \nF","year":"2023"},{"key":"CIT0023","series-title":"Br J Radiol","first-page":"770\u20137","article-title":"Diagnostic performance of multidetector CT for acute cholangitis: evaluation of a CT scoring method","volume":"85","author":"Kim\n \nSW","year":"2012;"},{"key":"CIT0024","series-title":"J Visc Surg","first-page":"515\u201325","article-title":"Acute cholangitis: diagnosis and management","volume":"156","author":"Sokal\n \nA","year":"2019;"},{"key":"CIT0025","series-title":"Relatos Caso do CBC","first-page":"3","article-title":"Biliary tract obstruction secondary to a foreign body: chambered projectile in common hepatic duct","author":"Tamasauskas\n \nI","year":"2016;"},{"key":"CIT0001","series-title":"Ann 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bile leak and ductal injury: management strategy and outcomes","volume":"226","author":"Fong\n \nZV","year":"2018;"},{"key":"CIT0006","series-title":"Surg Endosc","first-page":"4294\u20139","article-title":"Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy","volume":"30","author":"Halbert\n \nC","year":"2016;"},{"key":"CIT0007","series-title":"Abdom Imaging","first-page":"748\u20139","article-title":"Biliary obstruction secondary to combat-related foreign bodies: report of two cases","volume":"30","author":"Kamona\n \nA","year":"2005;"},{"key":"CIT0008","series-title":"Surg Endosc","first-page":"3079\u201384","article-title":"Bile duct injuries: a contemporary survey of surgeon attitudes and experiences","volume":"34","author":"Fletcher\n \nR","year":"2019;"},{"key":"CIT0009","series-title":"World J Gastrointest Surg","first-page":"43\u20138","article-title":"Classification and management of bile duct injuries","volume":"3","author":"Mercado\n \nMA","year":"2011;"},{"key":"CIT0010","series-title":"Chirurg","first-page":"681\u20134","article-title":"Neue WSES-AAST-Leitlinie zum Trauma des Duodenums, des Pankreas und der extrahepatischen Galleng\u00e4nge \u2013 Zusammenfassung und Kommentar [New WSES-AAST guideline on duodeno-pancreatic and extrahepatic biliary tree trauma-summary and comments]","volume":"91","author":"Hecker\n \nA","year":"2020;"},{"key":"CIT0011","series-title":"J Pediatr Surg","first-page":"345\u20138","article-title":"Treatment and outcome of traumatic biliary injuries in children","volume":"49","author":"Soukup\n \nES","year":"2014;"},{"key":"CIT0012","series-title":"J Trauma Acute Care Surg","first-page":"1620\u20135","article-title":"Management of blunt and penetrating biliary tract trauma","volume":"72","author":"Thomson\n \nBN","year":"2012;"},{"key":"CIT0013","series-title":"Int J Surg Case Rep","first-page":"276\u20139","article-title":"Late cholestatic syndrome due to previous perforating trauma: case report","volume":"61","author":"De Macedo\n \nFPPC","year":"2019;"},{"key":"CIT0014","series-title":"J Trauma","first-page":"157\u20138","article-title":"Delayed presentation of a penetrating biliary tract injury in a child","volume":"40","author":"Rescorla\n \nFJ","year":"1996;"},{"key":"CIT0015","series-title":"Clin Radiol","first-page":"334\u20135","article-title":"Bullet in the common hepatic duct: a cause of obstructive jaundice","volume":"58","author":"Maheshwari\n \nM","year":"2003;"},{"key":"CIT0016","series-title":"Gastrointest Endosc","first-page":"194\u20135","article-title":"Endoscopic removal by ERCP of a foreign body (bullet) in the common bile duct","volume":"94","author":"Calderon\n \nAJ","year":"2021;"},{"key":"CIT0017","series-title":"J Coll Physicians Surg Pak","first-page":"232\u20133","article-title":"Delayed obstructive jaundice secondary to bullet in common hepatic duct","volume":"17","author":"Hussain\n \nSM","year":"2007;"},{"key":"CIT0018","series-title":"Gastrointest Endosc","first-page":"147\u201350","article-title":"Pancreatic foreign body: ingested toothpick as a cause of pancreatitis and hemorrhage","volume":"59","author":"Kim\n \nKH","year":"2004;"},{"key":"CIT0019","series-title":"Neurol Res","first-page":"475\u201380","article-title":"Incidence of intracranial bullet fragment migration","volume":"21","author":"Rapp\n \nLG","year":"1999;"},{"key":"CIT0020","series-title":"Mil Med","first-page":"e107\u201313","article-title":"Extra-articular retained missiles; Is surveillance of lead levels needed?","volume":"183","author":"Nickel\n \nWN","year":"2018;"},{"key":"CIT0021","series-title":"Urol Case Rep","first-page":"101016","article-title":"Migrated bullet in the bladder presenting 18 years after a gunshot wound","volume":"28","author":"Marantidis\n \nJ","year":"2019;"},{"key":"CIT0022","series-title":"In: StatPearls","article-title":"Bile duct injury","author":"Moghul\n \nF","year":"2023"},{"key":"CIT0023","series-title":"Br J Radiol","first-page":"770\u20137","article-title":"Diagnostic performance of multidetector CT for acute cholangitis: evaluation of a CT scoring method","volume":"85","author":"Kim\n \nSW","year":"2012;"},{"key":"CIT0024","series-title":"J Visc Surg","first-page":"515\u201325","article-title":"Acute cholangitis: diagnosis and management","volume":"156","author":"Sokal\n \nA","year":"2019;"},{"key":"CIT0025","series-title":"Relatos Caso do CBC","first-page":"3","article-title":"Biliary tract obstruction secondary to a foreign body: chambered projectile in common hepatic duct","author":"Tamasauskas\n \nI","year":"2016;"}],"container-title":["Qatar Medical 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