Endoscopic ultrasonography-guided hepaticogastrostomy as a bridge to the definitive biliary reconstruction in a pediatric patient with left hepatic duct disruption secondary to blunt liver trauma

Abstract

Abstract Case report Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is a minimally invasive technique for biliary system drainage that is used in adult patients with biliary obstruction whose papilla of Vater cannot be accessed. We report a pediatric patient who developed complete obstruction of left hepatic duct associated with liver injury and underwent EUS-HGS as a bridge to the definitive biliary reconstruction. A 7-year-old boy sustained a liver injury (Grade IV) developed bile peritonitis post-traumatic day 17 and underwent perihepatic drainage followed by endoscopic retrograde cholangiopancreatography, which revealed persistent bile leakage from B8. The left biliary system was not visible. A 7-Fr plastic stent was placed into the right biliary system, but 1 week later the patient developed diffuse dilatation of the left biliary system due to complete obstruction of left hepatic duct. EUS-HGS was performed to drain the left biliary system. A dilated bile duct (B2) was accessed using a needle through the EUS probe. A 7-Fr plastic stent was placed into B2 over the guidewire. Eight months later, he underwent elective exploratory laparotomy and hepaticojejunostomy by pediatric hepatobiliary surgeons. Conclusion Temporarily draining the biliary system by EUS-HGS is a viable option prior to definitive biliary reconstructive surgery.