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Traumatic bile leaks from blunt liver injury in children: a multidisciplinary and minimally invasive approach to management.

Abstract：

BACKGROUND:Selective non-operative management (NOM) of hemodynamically stable pediatric patients with blunt hepatic trauma is the standard of care. Traumatic bile leaks (TBL) are a potential complication following liver injury. The use of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of TBL is described in adults, but limited in the pediatric literature. We report our experience with a multidisciplinary and minimally invasive approach to the management of TBL. METHODS:This was an IRB-approved 13-year retrospective review (January 1999-December 2012) of an institutional pediatric trauma registry; 294 patients (≤ 17 years old) sustained blunt hepatic injury. Those with TBL were identified. Patient demographics, mechanism of injury, management strategy and outcomes were reviewed. RESULTS:Eleven patients were identified with TBL. Hepatobiliary iminodiacetic scan (HIDA) was diagnostic. Combinations of peri-hepatic drain placement, ERCP with biliary stenting and/or sphincterotomy were performed with successful resolution of TBL in all cases. No child required surgical repair or reconstruction of the leak. Cholangitis developed in one child. There were no long-term complications. CONCLUSIONS:A multidisciplinary and minimally invasive approach employing peri-hepatic external drainage catheters and ERCP with sphincterotomy and stenting of the ampulla is a safe and effective management strategy for TBL in children.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Kulaylat AN,Stokes AL,Engbrecht BW,McIntyre JS,Rzucidlo SE,Cilley RE

doi

10.1016/j.jpedsurg.2013.07.015

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

424-7

issue

3

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(13)00645-3

journal_volume

49

pub_type

杂志文章

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