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To the Editor:—
May I comment on the query concerning "post-traumatic jaundice" in The Journal (174:1357 [Nov. 5] 1960) and the reply attributing the jaundice to possible laceration of the liver and absorption of extravasated bile.The circumstances described in the inquiry, that is, a mild injury (not specifically of the hepatic region) without immediately apparent consequences, jaundice appearing 2 weeks later, and "fibrosis" (obstruction?) of the common bile duct a week after that, could equally well be interpreted as hyperbilirubinemia due to absorption of blood from a traumatic hematoma, hemoperitoneum, or retroperitoneal hemorrhage.The jaundice may be due to a load of bilirubin exceeding excretory capacity, to obstruction of bile canaliculi by such an overload, or to intraductal bilirubin concretions, as seen in hemolytic anemia. In the absence of further data the "fibrosis of the common bile duct" might be interpreted as obstruction by such a concretion.
Marks HE. Post-Traumatic Jaundice. JAMA. 1961;175(7):633. doi:10.1001/jama.1961.03040070091032
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