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Non operative management of blunt bile duct injuries in children
Mohammed S Mallick1, Abdulrahman A Al-Bassam, Ahmed A Boukai
1Division of Pediatric Surgery, Department of Surgery, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Insights
Non-operative management of bile duct injuries in children following blunt abdominal trauma can be successful. Advanced endoscopic and radiological techniques enable conservative treatment for pediatric bile duct injuries, leading to good outcomes.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Abdominal trauma management
Background:
- Bile duct injuries (BDI) following blunt abdominal trauma are uncommon in pediatric patients.
- Traditional management often involves surgical intervention, but non-operative approaches are increasingly explored.
Observation:
- Two pediatric cases of blunt bile duct injuries are presented.
- Case 1: Partial tear of the right hepatic duct managed with endoscopic retrograde cholangiopancreatography (ERCP) stenting.
- Case 2: Intrahepatic bile duct injury with associated liver trauma treated with percutaneous sub-hepatic drainage.
Findings:
- Both patients achieved successful non-operative BDI healing without stricture formation at 2-year follow-up.
- Long-term outcomes included symptom-free status, normal liver function tests, and normal liver ultrasound findings.
- Conservative management facilitated ductal healing and preserved liver function.
Implications:
- Advanced radiological and endoscopic techniques support the conservative management of select pediatric bile duct injuries.
- Individualized treatment strategies based on injury location and severity are crucial for successful non-operative outcomes.
- Non-operative BDI management offers a viable alternative, potentially reducing morbidity in pediatric trauma patients.
Abstract:
Bile duct injuries after blunt abdominal trauma are rare in children. This report describes 2 cases of blunt bile duct injuries in children, which were managed non-operatively. One patient sustained partial tear in the right hepatic duct, which was managed successfully by passing a stent into the injured duct during endoscopic retrograde cholangio pancreatography. The 2nd patient had intrahepatic bile duct injury associated with liver trauma and was managed with a drain placed in the sub-hepatic area percutaneously. This non-operative management in our patients allowed healing of bile duct injuries without any stricture, at 2 years follow-up. Both children are symptom free with normal liver function tests and normal liver ultrasound. With the advancement in radiological and endoscopic techniques, some of the bile duct injuries can be managed conservatively. Conservative treatment must be individualized according to the site and extent of injury.