A rare case of abdominal gunshot trauma: Isolated common bile duct injury within the portal triad accompanied by liver and lung injury

Injuries to the common bile duct (CBD) have been reported in 0.4-0.5% of penetrating trauma cases across several series. Gunshot wounds pose unique challenges due to the thermal injury caused by the projectile, combined with the close anatomical proximity of the CBD, portal vein, and hepatic artery within the hepatoduodenal ligament. This proximity often results in combined injuries to these vital structures, which are associated with high perioperative morbidity or mortality. Isolated injuries to the CBD within the hepatoduodenal ligament are exceptionally rare, given the structure's protective location and the interconnected nature of its compo-nents. The management of isolated CBD injuries remains a topic of ongoing debate. Here, we present a rare case of a gunshot wound causing an isolated CBD injury within the portal triad, accompanied by concomitant injuries to other intra-abdominal and thoracic organs.We present a 41-year-old male patient with an isolated CBD injury within the portal triad, accompanied by liver and lung injury sustained from a gunshot. Emergency computed tomography (CT) imaging revealed a bullet trajectory of 14 cm extending from liver segment 6 to segment 4B, associated with laceration and contusion. Exploration revealed thermal damage to the gallbladder wall, and the integrity of the hepatoduodenal ligament was disrupted. A cholecystectomy was performed, and dissection of the hepatoduodenal ligament revealed that approximately 70% of the CBD wall was transected. Importantly, the portal vein and hepatic artery remained intact. The proximal CBD was clamped, and complete transection of the duct was performed. Reconstruction involved a Roux-en-Y hepaticojejunostomy after preparing the jejunal segment. The patient experienced an uneventful recovery and was discharged on postoperative day 7 following drain removal. At the 6-month follow-up, the patient remained asymptomatic with no evidence of late complications.We believe that dissection of the hepatoduodenal ligament is necessary in patients with penetrating injuries near the hepatoduodenal ligament after hemostasis. Hepaticojejunostomy is an effective surgical treatment for patients with full-thickness transection of the CBD and reduces the risk of postoperative complications.