Abdulkerim Temiz1, Semire Serin Ezer2, Murat Gedikoğlu3, Ender Serin4, Emine İnce2, Hasan Özkan Gezer2, Mehmet Oğuz Canan5, Akgün Hiçsönmez2. 1. Department of Pediatric Surgery, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Dadaloğlu mah. 39 sokak, No: 6, Yüreğir, 01250, Adana, Turkey. aktemiz@yahoo.com. 2. Department of Pediatric Surgery, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Dadaloğlu mah. 39 sokak, No: 6, Yüreğir, 01250, Adana, Turkey. 3. Department of Radiology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Adana, Turkey. 4. Department of Gastroenterology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Adana, Turkey. 5. Department of Pediatric Gastroenterology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Adana, Turkey.
Abstract
PURPOSE: Pediatric experience with biliary tract injuries (BTI) is limited and mostly consists of case presentations. The purpose of this study is to evaluate clinical and radiological findings of possible BTI, treatment strategies, and results. METHODS: The records of nine patients with the diagnosis of BTI between July 2009 and November 2017 were reviewed retrospectively. RESULTS: There were seven boys and two girls (mean 8.05 ± 4.39 years). The mechanisms were motor vehicle occupant, fall, crush and gunshot wound. Hepatic laceration routes that extended into the porta hepatis and contracted the gall bladder were demonstrated on computerized tomography (CT). Bile duct injury was diagnosed with bile leakage from the thoracic tube (n = 2), from the abdominal drain (n = 2) and by paracentesis (n = 5). Extrahepatic (n = 8) and intrahepatic (n = 1) bile duct injuries were diagnosed by cholangiography. Endoscopic retrograde cholangiography, sphincterotomy, and stent placement were successfully completed in five patients. Peritoneal drainage stopped after 3-17 days of procedure in four patients. The fifth patient was operated with the diagnosis of cystic duct avulsion. Cholecystectomies, primary repair of laceration, cystic duct ligation, and Roux-en-Y hepatoportoenterostomy were performed in the remaining four patients. All patients presented with clinically normal findings, normal liver functions, and normal ultrasonographic findings in the follow-up period. CONCLUSIONS: The presentation of the parenchymal injury extending to the porta hepatis with contracted gall bladder on CT and diffuse homogenous abdominal fluid should be considered as signs of BTI. We suggest a multi-disciplinary approach for the diagnosis and treatment of BTIs. Surgery may be indicated according to the patient's clinical condition, radiological findings and failure of non-operative treatment.
PURPOSE: Pediatric experience with biliary tract injuries (BTI) is limited and mostly consists of case presentations. The purpose of this study is to evaluate clinical and radiological findings of possible BTI, treatment strategies, and results. METHODS: The records of nine patients with the diagnosis of BTI between July 2009 and November 2017 were reviewed retrospectively. RESULTS: There were seven boys and two girls (mean 8.05 ± 4.39 years). The mechanisms were motor vehicle occupant, fall, crush and gunshot wound. Hepatic laceration routes that extended into the porta hepatis and contracted the gall bladder were demonstrated on computerized tomography (CT). Bile duct injury was diagnosed with bile leakage from the thoracic tube (n = 2), from the abdominal drain (n = 2) and by paracentesis (n = 5). Extrahepatic (n = 8) and intrahepatic (n = 1) bile duct injuries were diagnosed by cholangiography. Endoscopic retrograde cholangiography, sphincterotomy, and stent placement were successfully completed in five patients. Peritoneal drainage stopped after 3-17 days of procedure in four patients. The fifth patient was operated with the diagnosis of cystic duct avulsion. Cholecystectomies, primary repair of laceration, cystic duct ligation, and Roux-en-Y hepatoportoenterostomy were performed in the remaining four patients. All patients presented with clinically normal findings, normal liver functions, and normal ultrasonographic findings in the follow-up period. CONCLUSIONS: The presentation of the parenchymal injury extending to the porta hepatis with contracted gall bladder on CT and diffuse homogenous abdominal fluid should be considered as signs of BTI. We suggest a multi-disciplinary approach for the diagnosis and treatment of BTIs. Surgery may be indicated according to the patient's clinical condition, radiological findings and failure of non-operative treatment.
Entities:
Keywords:
Bile leakage; Biliary; Cholangiography; Endoscopic treatment; Injury
Authors: Marco Castagnetti; Christopher Houben; Shailesh Patel; John Devlin; Philip Harrison; John Karani; Nigel Heaton; Mark Davenport Journal: J Pediatr Surg Date: 2006-09 Impact factor: 2.545