Selective role for endoscopic retrograde cholangiopancreatography in abdominal trauma

Emergency endsocopic retrograde cholangiopancreatography (ERCP) is rarely indicated in trauma patients; however, in cases of suspected pancreatic or bile duct injury or bile leak, it may be useful. The purpose of this paper is to review our ERCP experience in trauma patients. Our Level I Trauma Center admits 1800 patients annually.

Since January 1991, we have performed ERCP in 12 trauma patients, nine after blunt injury and three after penetrating injury.

ERCP was used as a diagnostic tool to evaluate the pancreatic duct in six stable patients with equivocal CT scans and unexplained abdominal pain, fever, and an elevated amylase or a peripancreatic pseudocyst. Based on their ERCP findings-one intact pancreatic duct, one transected duct, and four pseudocysts-five of the six patients had operations. We performed ERCP in six patients for persistent bile leaks (five cases) or jaundice (one case). The findings were one case of bilemia (intrahepatic biliovenous fistula), one case of common bile duct disruption, and four cases of persistent bile leaks from the liver after liver injuries. Endobiliary stents placed in five patients successfully stopped the four bile leaks and closed the biliovenous fistula. The one case of ductal disruption required an open choledochojejunostomy. The only ERCP complication was an episode of cholangitis treated with antibiotics. The earliest ERCP was 3 days after injury, and most were performed within 2 months.

ERCP is a helpful procedure for diagnosing biliary and pancreatic duct injury in a select group of trauma patients who do not have obvious indications for exploration. In addition, ERCP techniques are also effective for treating most bile leaks.