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Blunt bile duct injuries in children
S L Moulton1, E C Downey, D S Anderson
1Department of Surgery, University of California, San Diego.
Insights
Blunt liver injuries in children can lead to bile leakage, even with initial nonoperative management. Late intervention may be needed for bile leaks, with treatment tailored to injury severity and location.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Trauma Surgery
Background:
- Blunt liver injuries are common in children.
- Initial nonoperative management is often attempted for pediatric blunt liver injuries.
- Bile leakage is a potential complication of liver trauma.
Observation:
- Three children with blunt liver injuries initially managed nonoperatively developed late bile leakage.
- These cases involved injuries extending into the porta hepatis.
- Symptoms included persistent abdominal pain, low-grade fever, and prolonged ileus.
Findings:
- Radionucleide scans confirmed bile leakage.
- Injuries ranged from complete common bile duct transection to partial hepatic duct transection and intrahepatic injury.
- Surgical repair, transampullary biliary decompression, and drainage were employed.
- Transampullary biliary decompression proved effective for proximal/partial bile duct injuries.
Implications:
- Nonoperative management of pediatric blunt liver injuries carries a risk of delayed bile leakage.
- Radionucleide scan and endoscopic retrograde cholangiopancreatography are crucial for diagnosis.
- Transampullary biliary decompression offers a viable treatment option for specific bile duct injuries.
- Individualized treatment based on injury characteristics is essential for optimal outcomes.
Abstract:
Three of 87 children with blunt liver injuries initially managed without operation required late intervention for bile leakage. Abdominal computed tomography scans in these patients showed liver injuries extending into the porta hepatis. Clinical courses were characterized by persistent abdominal pain, low-grade fever, and prolonged ileus. Radionucleide scan confirmed the suspicion of bile leakage. One patient had complete transection of the common bile duct, which was repaired surgically. Another had partial transection of the left hepatic duct, managed successfully with transampullary biliary decompression. The third patient with an intrahepatic injury was managed with a drain placed at celiotomy. Nonoperative management of blunt pediatric liver injuries carries a risk of persistent bile leakage. Radionucleide scan and endoscopic retrograde cholangiopancreatography are reliable modes of diagnosis and localization. Transampullary biliary decompression is a newer, effective modality for management of the proximal and/or partial bile duct injuries. Treatment must be individualized according to the site and extent of injury.