Delayed diagnosis of isolated common bile duct injury in an infant: Efficacy of transcystic duct catheter in staged surgical management

Isolated common bile duct (CBD) injuries following blunt abdominal trauma are exceptionally rare in infants and often present a diagnostic challenge. Due to the retroperitoneal location of the CBD and the potentially mild peritoneal response to bile leakage, early symptoms may be subtle or absent. As a result, diagnosis is frequently delayed. We present a case of a 2-year-old child who was diagnosed on the 14th day after blunt trauma caused by a falling television unit. Imaging and surgical findings confirmed an isolated CBD injury. The patient was treated with the two-stage surgical approach using transcystic duct catheter drainage followed by delayed reconstruction. The initial procedure involved damage control surgery, including biliary drainage via a transcystic duct catheter and thorough peritoneal irrigation. Four months later, the definitive reconstruction was performed with a Roux-en-Y hepaticojejunostomy. This case emphasizes that isolated CBD injuries, though rare in infants, can follow blunt abdominal trauma and may present with delayed symptoms due to bile's low peritoneal irritancy. This case underscores the rarity and novelty of the transcystic duct catheter approach when managing bile leakage in an infant prior to definitive surgical reconstruction.