Iatrogenic trauma of pancreaticobiliary junction        SHI Wei-jin. Department of Surgery，Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Abstract    Iatrogenic trauma of the pancreaticobiliary junction is sometimes inevitable because of its unique anatomy, special pathologic changes and some operations undergoing without direct vision. Because the clinical features are usually inconspicuous, which is responsible for delayed diagnosis, the result is disastrous. The surgeon should always remind himself of the possibility of accidental trauma during operations on that area, which is the key for prevention and early detection. Retroperitoneal edema or exudates after injection into the T tube or exudation of contrast medium during cholangiography implies the existence of trauma. It should immediately make great effort to locate the site, suture the leak and drain the bile. If the leakage can’t be located, end-to-side choledochojejunostomy is recommended to separate the biliary and pancreatic flow. Chill, fever and back pain 1~2 days after operation are the signs of leakage in the retroperitonaeum and infection. Sometimes the pus may flow to the right iliac fossa which may cause right lower quadrant abdominal pain and tenderness. Prompt surgery to drain the abcess, separate the biliary and pancreatic flow, diverticularize the duodenum and jejunostomy for enteral nutrition is necessary.