[Conservative treatment of traumatic rupture of the biliary ducts: a case report]
L Carfagna1, H Steyaert, M A Lembo
1Service de chirurgie pédiatrique, Fondation Lenval, hôpital pour enfants, 57, avenue de la Californie, 06200, Nice, France.
Insights
Diagnosing biliary duct transection in children after blunt trauma is challenging. This case highlights a minimally invasive approach and reviews advanced imaging techniques for prompt diagnosis and treatment.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Biliary duct transection following blunt abdominal trauma presents diagnostic challenges in pediatric patients.
- Delayed diagnosis often leads to complicated surgical interventions.
Observation:
- A case of a 12-year-old child with biliary duct transection managed with a mini-invasive approach is presented.
- Traditional diagnostic methods like transhepatic cholangiography require general anesthesia.
- Endoscopic retrograde cholangiogram (ERCP) is an alternative, potentially simplifying stent placement.
Findings:
- Technetium 99m dimethyliminodiacetic acid (HIDA) scanning demonstrates high sensitivity and specificity for diagnosing biliary duct injuries.
- Magnetic Resonance Imaging (MRI) with 3D reconstruction offers another promising non-invasive diagnostic modality.
Implications:
- Minimally invasive techniques and advanced imaging like HIDA scans and MRI can improve the diagnosis and management of pediatric biliary duct injuries.
- Early and accurate diagnosis is crucial to optimize surgical outcomes and reduce complications in children.
Abstract:
The diagnosis of a biliary duct transection after blunt trauma is difficult in children. Surgery is often performed late and therefore complicated. We present a case of mini-invasive approach for biliary duct transection in a 12-year-old child and review the literature. Transhepatic cholangiography is at the moment the most used technique to make the diagnosis but necessitates general anaesthesia. Stent placement is possible by the way. Endoscopic retrograde cholangiogram (ERCP) has been proposed even in children. Stent placement may be easier by this technique. For the diagnosis, Technetium 99m dimethylminodiacetic acid (HIDA) scanning seems interesting in terms of both sensitivity and specificity. Another promising diagnostic technique is MRI with 3D reconstruction.