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An unusual bile duct injury in a child after blunt abdominal trauma
S Bin Yahib1, A Al Rabeeah, A Al Sammarrai
1Department of Surgery, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
Insights
Pediatric bile duct injuries from blunt abdominal trauma are rare. This case highlights successful surgical repair of complex bile duct injuries in a child, leading to a full recovery.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Trauma surgery
Background:
- Bile duct injuries (BDIs) are uncommon complications following pediatric blunt abdominal trauma.
- Early diagnosis and management are crucial for optimal outcomes.
Observation:
- A 3-year-old child presented with blunt abdominal trauma, leading to injuries of the bile duct, liver, and small bowel.
- Initial management included small bowel repair, but a significant biliary leak developed postoperatively.
Findings:
- Diagnostic imaging (radioisotope scan, ERCP) revealed injuries to both right and left hepatic ducts, along with an anomalous bile duct course.
- Surgical repair involved primary repair of the right hepatic duct and Roux-en-Y hepaticojejunostomy for the left hepatic duct.
Implications:
- This case demonstrates the successful management of complex pediatric bile duct injuries, even with associated anomalies.
- Effective surgical reconstruction can restore normal bile flow and lead to long-term symptom-free recovery in pediatric trauma patients.
Abstract:
Bile duct injuries are rare in children after blunt trauma. This report describes a 3-year-old child who sustained a blunt abdominal trauma resulting in bile duct, liver, and small bowel injuries. The initial management at another hospital included recognition and repair of a small bowel perforation. However, the postoperative course was complicated by a large biliary leak. The child was transferred to our institution where radioisotope scanning and endoscopic retrograde cholangiography confirmed the extent of the ductal injury. At laparotomy there were injuries of both right and left hepatic ducts, and an anomaly of bile duct course was noted. The right hepatic duct was repaired primarily and the left one was repaired with Roux-en-Y hepaticojejunostomy. Postoperatively, normal bile drainage was documented by radioisotope scan and the patient remains symptom free at 1 year follow-up.