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The incidence of hyponatremia in a study of 208 patients with common duct exploration was determined. The total amount and the daily average biliary drainage were calculated on all patients. The importance of the amount of daily biliary drainage, the total amount of biliary drainage, and the effect of prolonged drainage are discussed as factors in the development of hyponatremia. The causative factors for increased drainage volumes in the patients in whom hyponatremia developed are analyzed. The additional effects of pre-existing adrenocortical or renal disease or the treatment of cardiac disease are discussed as factors in the development of hyponatremia.

Primary sclerosing cholangitis is an uncommon condition of unknown etiology, presenting extrahepatic biliary obstruction due to a chronic inflammatory obliterative process. Criteria for diagnosis include progressive biliary obstruction due to a chronic inflammatory fibrous process, absence of biliary stones, absence of biliary surgery prior to onset of symptoms, and a follow-up period long enough to exclude sclerosing carcinoma of the biliary tree. Long-term prognosis is generally considered to be poor. Our patient was treated by resection of the hyperplastic fibrous inner wall making possible T tube drainage. Steroids and antibiotics were given, and the patient is alive and well three years later.

Traumatic hemobilia is a major complication of liver trauma which is being recognized with increasing frequency. Prevention of hemobilia of intrahepatic origin would appear to depend upon thorough exploration and debridement of major hepatic injuries as well as provision for the external drainage of bile. Controlled biliary decompression utilizing T tube drainage of the common duct is recommended as a major adjuvant in the management of severe liver injuries. The progressively decreasing morbidity and mortality of traumatic hemobilia is the result of more aggressive surgical management. Hemobilia originating with one lobe is best treated by excision of the involved hepatic segment or lobectomy when necessary. Hemobilia originating from a central hepatic cavity is best treated by wide exposure of the cavity and direct ligation of the bleeding vessels. A patient with traumatic hemobilia of central hepatic origin is presented in detail. The surgical management of previously reported cases of intrahepatic traumatic hemobilia is reviewed and summarized.