Traumatic Bile Research Articles

Management of Traumatic Liver and Bile Duct Laceration

Posttraumatic major bile leak in children is uncommon, with few cases reported in the literature. These injuries are seen in high-grade liver trauma and are difficult to diagnose and manage. We describe a 7-year-old boy with grade IV hepatic trauma and bile leak following blunt abdominal trauma. The leak was successfully managed by percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP) stenting of the injured hepatic duct.How to cite this article: Tiwari C, Shah H, Waghmare M, Khedkar K, Dwivedi P. Management of Traumatic Liver and Bile Duct Laceration. Euroasian J Hepato-Gastroenterol 2017;7(2):188-190.

Percutaneous Treatment of Iatrogenic and Traumatic Injury of the Biliary System

Traumatic or iatrogenic bile duct injury (BDI) includes bile leaks, benign stenoses, and fistulae. These complications result in significant morbidity and mortality. This review will provide insight into the presentation, diagnosis, classification, and percutaneous management of BDI. Prompt diagnosis through non-invasive imaging and minimally invasive procedures is paramount to improved patient outcomes. Numerous classifications of BDI exist, although none are universally accepted. Percutaneous approaches to the management of BDI offer a minimally invasive alternative to traditional surgery. Bile leaks are primarily treated with drainage and decompression; however, adjunctive techniques such as embolization are also presented. Fistulae are routinely treated with embolization even though limited literature exists to provide a consensus treatment algorithm. Benign stenosis is primarily treated with balloon dilation with long-term biliary intubation while placement of bile duct stents is often reserved for patients with recurrent stricture. Iatrogenic or traumatic BDI typically requires a multidisciplinary team approach, although prompt diagnosis and advances in therapeutic approaches have improved patient outcomes.

Endoscopic treatment of bile duct post-traumatic and post-operative lesions in children

Background and study aims: The aim of this study was to assess the significance and safety of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating bile duct injuries in children.Patients and methods: Fourteen pediatric patients, with traumatic or postoperative bile duct injury, in which ERCP was performed, were retrospectively evaluated.Results: We performed 46 ERCP and 12 endoscopic papillotomies in children with suspected bile duct injuries. A bile stent was primarily inserted in 13 patients and there were 20 replacements. Endoscopic treatment of bile leakage without need for bile duct sutures or reconstruction was successful in 85.7%. Post ERCP complications included cholangitis and recurrent bleeding, which occurred only in two patients each.Conclusions: ERCP and endoscopic bile stent insertion is a highly effective, minimally-invasive treatment for bile duct injury and should be included as part of the therapeutic procedures in pediatric patients with suspected bile duct injury.

Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor

Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor

Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor

We report the case of an ultimately successful liver transplant recipient whose post-transplant course was complicated by the early development of multiple abscesses in the graft. Post-transplant cholangiography identified multiple shear injuries to the second and third order intrahepatic bile ducts, originating from blunt trauma to the donor liver. Treatment was non-operative following recent reports of the successful management of intrahepatic bile duct injury in the stable trauma patient. This discussion adds to the limited literature available on the transplantation of injured donor livers, despite this being a relatively common practice. Further experience is needed in determining the appropriate criteria for the use of traumatized donor livers. Cholangiography carried out on the back table may help to determine if such injured livers are suitable for transplantation.

Endoscopic biliary stents for treatment of traumatic intrahepatic bile leaks

Endoscopic biliary stents for treatment of traumatic intrahepatic bile leaks