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[Modern diagnosis and therapy of traumatic hemobilia in childhood]
Insights
This study presents the first childhood case of haematobilia diagnosed using sonography. Early sonographic detection of liver aneurysms post-rupture is crucial for reducing mortality.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Hepatology
Background:
- Liver rupture in children can lead to severe complications.
- Postoperative monitoring is essential for identifying delayed complications.
- Haematobilia, bleeding into the biliary tract, is a rare but serious condition.
Observation:
- A six-year-old boy presented with massive haematemesis 57 days post-liver rupture repair.
- Sonography revealed an atonic gallbladder with coagulates and a liver aneurysm with pulsatile flow.
- The aneurysm was located in a necrotic cavity at the liver floor.
Findings:
- Sonography successfully diagnosed haematobilia in a pediatric patient.
- The diagnostic capabilities of ultrasound were demonstrated for identifying intrahepatic vascular abnormalities.
- Successful surgical intervention (relaparotomy with ligature) was guided by sonographic localization.
Implications:
- Early and regular sonographic examinations are vital for postoperative liver rupture management.
- Sonography can significantly reduce the high mortality associated with liver rupture complications.
- Intraoperative sonography offers precise localization of bleeding sources, improving surgical outcomes.
Abstract:
The authors report on the first case of haematobilia diagnosed in childhood by means of sonography. Massive haematemesis occurred in a six-year-old boy on the 57th postoperative day after an oversewn rupture of the liver. Sonography revealed an atonic gallbladder with stratification phenomena and free floating highly reflecting coagulates, as well as pulsations and flow phenomena in an area of the size of a bean at the floor of a necrotic cavity of the liver (aneurysm). Relaparotomy was done by locating the aneurysm via sonography and performing a purse-string ligature. The high mortality rate of 10 to 20% can be reduced if the gradually evolving condition is identified at an early stage, which means that regular sonographic examinations should be conducted in the postoperative control of liver rupture. Intraoperative sonography with sterilisable sound heads enables accurate location of the source of bleeding.