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Ali SW, Salim A, Aslam U, Khalid S, Ashraf MS, Khan MAM. Multidisciplinary management of high-grade pediatric liver injuries. Eur J Trauma Emerg Surg 2024; 50:829-836. [PMID: 38240790 DOI: 10.1007/s00068-023-02439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/28/2023] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To present our experience of multidisciplinary management of high-grade pediatric liver injuries. INTRODUCTION Pediatric high-grade liver injuries pose significant challenge to management due to associated morbidity and mortality. Emergency surgical intervention to control hemorrhage and biliary leak in these patients is usually suboptimal. Conservative management in selected high-grade liver injuries is now becoming standard of care. Management of hemobilia due to pseudoaneurysm formation and traumatic bile leaks requires multidisciplinary management. METHODS A retrospective review was undertaken for patients presenting with blunt liver injuries at two tertiary care centers in Karachi, Pakistan, from March 2021 to December 2022. Twenty-eight patients were identified, and four patients fulfilled the criteria for grade 4 and above blunt liver injury during this period. RESULTS One case with grade 4 liver injury developed hemobilia on 7th day of injury. He required two settings of angioembolization but had recurrent leak from pseudoaneurysm. He ultimately needed right hepatic artery ligation. Second patient presented with massive biliary peritonitis 2 days following injury. He was managed initially with tube laparostomy followed by ERCP and stent placement. The third patient developed large hemoperitoneum managed conservatively. One case with grade 5 injury expired during emergency surgery. CONCLUSION Conservative management of advanced liver injuries can result in significant morbidity and mortality due to high risk of complications. Trauma surgeons need to have multidisciplinary team for management of these patients to gain optimal outcome.
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Affiliation(s)
- Syed Waqas Ali
- Department of Pediatric Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Areej Salim
- Department of Pediatric Surgery, Aga Khan University, Karachi, Pakistan
| | - Uzair Aslam
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Saad Khalid
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Muhammad Arif Mateen Khan
- Department of Pediatric Surgery, Dow University of Health Sciences, Karachi, Pakistan.
- Pediatric Surgery, Aga Khan University of Health Sciences, Karachi, Pakistan.
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2
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Schunn MC, Schäfer J, Neunhoeffer F, Lieber J, Fuchs J. [Blunt abdominal trauma in children and adolescents: treatment concepts in the acute phase]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:651-663. [PMID: 37338573 DOI: 10.1007/s00104-022-01798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 06/21/2023]
Abstract
Fatal accidents due to blunt force trauma are the leading cause of death in children and adolescents [1]. Abdominal trauma is the third most common cause of death after traumatic brain injury and thoracic injuries [2]. Abdominal injury is seen in approximately 2-5% of children involved in accidents [3]. Blunt abdominal injuries are common sequelae of traffic accidents (for example as seat belt injury), falls, and sports accidents. Penetrating abdominal injuries are rare in central Europe. Spleen, liver, and kidney lacerations are the most common injuries after blunt abdominal trauma [4]. In most situations, nonoperative management (NOM) has become the gold standard with the surgeon leading the multidisciplinary treatment [5].
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Affiliation(s)
- M C Schunn
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
| | - J Schäfer
- Diagnostische und Interventionelle Radiologie, Abteilung für Kinderradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - F Neunhoeffer
- Klinik für Kinderheilkunde, Abteilung für Kinderkardiologie, Intensivmedizin und Pulmonologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - J Lieber
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - J Fuchs
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
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3
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Mitricof B, Kraft A, Anton F, Barcu A, Barzan D, Haiducu C, Brasoveanu V, Popescu I, Moldovan CA, Botea F. Severe liver trauma with complex portal and common bile duct avulsion: A case report and review of the literature. World J Clin Cases 2023; 11:3837-3846. [PMID: 37383130 PMCID: PMC10294146 DOI: 10.12998/wjcc.v11.i16.3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Given its size and location, the liver is the third most injured organ by abdominal trauma. Thanks to recent advances, it is unanimously accepted that the non-operative management is the current mainstay of treatment for hemodynamically stable patients. However, those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical management. Moreover, an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability, thereby imposing therapeutic challenges in the tertiary referral hepato-bilio-pancreatic centers’ setting.
CASE SUMMARY We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion, due to a crush polytrauma. The patient was referred to the nearest emergency hospital and because of the hemorrhagic shock, damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery, and hemostatic packing. Afterwards, the patient was referred immediately to our tertiary hepato-bilio-pancreatic center. We performed depacking, a right hepatectomy and Roux-en-Y hepaticojejunostomy. On the 9th postoperative day, the patient developed a high output anastomotic bile leak that required a redo of the cholangiojejunostomy. The postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound pressure. The follow-up was optimal, with no complications at 55 mo.
CONCLUSION In conclusion, the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management, conducted in a tertiary referral hepato-bilio-pancreatic center, where a stepwise and complex surgical approach is mandatory.
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Affiliation(s)
- Bianca Mitricof
- Medicine Doctoral School, Titu Maiorescu University of Bucharest, Bucharest 040441, Romania
| | - Alin Kraft
- Department of General Surgery, Regina Maria Military Emergency Hospital, Brasov 500007, Romania
| | - Florentina Anton
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Alexandru Barcu
- Medicine Doctoral School, Titu Maiorescu University of Bucharest, Bucharest 040441, Romania
| | - Darina Barzan
- Dan Setlacec Center for General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Carmen Haiducu
- Dan Setlacec Center for General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Vladislav Brasoveanu
- Dan Setlacec Center for General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
- Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
| | - Irinel Popescu
- Dan Setlacec Center for General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
- Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
| | - Cosmin Alec Moldovan
- Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
| | - Florin Botea
- Dan Setlacec Center for General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
- Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
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Annam A, Josephs S, Johnson T, Kulungowski AM, Towbin RB, Cahill AM. Pediatric trauma and the role of the interventional radiologist. Emerg Radiol 2022; 29:903-914. [PMID: 35678950 DOI: 10.1007/s10140-022-02067-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE While interventional radiologists occupy a critical role in adult trauma management, the role of interventionalist in pediatric trauma continues to evolve. The indications for transarterial embolization (TAE) are significantly different in pediatric patients in whom non-operative management (NOM) has a much more prominent role than in adults. Contrast extravasation on imaging may not require acute surgical or interventional management as it would in an adult. There are also areas in which pediatric interventional radiology is increasingly useful such as pelvic TAE in failed management, or splenic embolization to treat bleeding without the loss of splenic function inherent to surgical splenectomy. The rapid evolution of techniques and devices in pediatric patients is also changing what interventions are possible in pediatric trauma management which necessitates frequent reassessment of the guidelines and interventional radiology's role in caring for these patients. CONCLUSION This review seeks to consolidate the recent literature to describe the evolving role of the interventional radiologist in pediatric trauma management.
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Affiliation(s)
- Aparna Annam
- Division of Pediatric Radiology, Department of Radiology, University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Shellie Josephs
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford Medicine, Palo Alto, CA, USA
| | - Thor Johnson
- Division of Vascular and Interventional Radiology, Medical University of South Carolina, Mount Pleasant, SC, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Richard B Towbin
- Emeritus Radiologist-in-Chief at Phoenix Children's Hospital, Phoenix, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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5
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The role of interventional radiology in the management of refractory bile leaks. Abdom Radiol (NY) 2022; 47:1881-1890. [PMID: 33733336 DOI: 10.1007/s00261-021-03016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Refractory bile leaks represent a damaging sequela of hepatobiliary surgery and direct trauma. Management of bile leaks represents a challenging clinical problem. Despite advances in endoscopic techniques, interventional radiology continues to play a vital role in the diagnosis and management of refractory bile leaks. This article reviews strategies for optimizing the diagnosis and management of bile leaks and provides an overview of management strategies, including the management of complicated biliary leaks.
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Stonelake S, Ali S, Pinkey B, Ong E, Anbarasan R, McGuirk S, Perera T, Mirza D, Muiesan P, Sharif K. Fifteen-Year Single-Center Experience of Biliary Complications in Liver Trauma Patients: Changes in the Management of Posttraumatic Bile Leak. Eur J Pediatr Surg 2021; 31:245-251. [PMID: 32422676 DOI: 10.1055/s-0040-1710391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Management of posttraumatic bile leak has evolved over time in our unit, from endoscopic retrograde cholangiopancreatography (ERCP) stenting to intraperitoneal drainage (IPD) alone as first-line treatment for intraperitoneal bile leak. MATERIALS AND METHODS Retrospective review of liver trauma patients from 2002 to 2017. Demographics, time and mode of diagnosis of bile leak, management, and outcome were analyzed of the box plot. RESULTS In 118 patients, there were 28 traumatic bile leaks. Eighteen were free intraperitoneal and 10 were localized bilomas. The median time of diagnosis was 6 days following injury. The modes of diagnosis were preemptive hepatobiliary scintigraphy (18), computed tomography (CT) or ultrasound (7), and laparotomy (3). Free intraperitoneal biliary leak management included 11 IPD alone, 3 IPD plus ERCP, 2 IPD plus transcystic biliary stent (TBS), 1 operative cholangiogram, and 1 no intervention. Median time of IPD duration was 7 days (4-95) in IPD alone versus 14 days (6-40) in IPD + ERCP/TBS (p = 0.3). Median inpatient length of stay was 13 days (8-44) in IPD alone versus 12 days (8-22) in IPD + ERCP/TBS (p = 0.4). CONCLUSION Placement of IPD alone, as first-line treatment, is safe and effective in the management of intraperitoneal bile leaks, avoiding the costs and potential complications of ERCP.
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Affiliation(s)
- Stephen Stonelake
- Birmingham Children's Hospital NHS Foundation Trust, Paediatric Surgery, Birmingham, United Kingdom
| | - Sana Ali
- Radiology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Benjamin Pinkey
- Radiology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Evelyn Ong
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
| | - Ravindar Anbarasan
- Birmingham Children's Hospital NHS Foundation Trust, Paediatric Surgery, Birmingham, United Kingdom
| | - Simon McGuirk
- Radiology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Thamera Perera
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
| | - Darius Mirza
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
| | - Paolo Muiesan
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
| | - Khalid Sharif
- Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
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7
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Pulliam K, Kotagal M, Lin TK, Patel MN. Use of glue embolization in management of traumatic bile leak: A case report. Trauma Case Rep 2021; 33:100468. [PMID: 33855156 PMCID: PMC8024764 DOI: 10.1016/j.tcr.2021.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/19/2022] Open
Abstract
Blunt abdominal trauma is a common cause of solid organ injury in children. Nonoperative management has been established as the standard of care for suspected liver and spleen injuries without peritonitis. Major ductal injury with resultant biloma is a rare complication of nonoperative management of blunt liver injury. Endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous drain placement are considered to be safe adjuncts in the management of these bile leaks. However, in the rare cases of persistent bile leak, further nonoperative alternatives have not been reported. In this case report we present a novel multidisciplinary approach to managing persistent bile leaks in blunt liver injury.
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Affiliation(s)
- Kasiemobi Pulliam
- Department of Surgery, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States of America
- Department of Surgery, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America
- Corresponding author at: 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States of America.
| | - Tom K. Lin
- Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States of America
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America
| | - Manish N. Patel
- Division of Interventional Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States of America
- Department of Radiology, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America
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8
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Abstract
The management of pediatric liver trauma has evolved significantly over the last few decades. While surgical intervention was frequently and mostly unsuccessfully practiced during the first half of the last century, the 1960s were witness to the birth and gradual acceptance of non-operative management of these injuries. In 2000, the American Pediatric Surgical Association (APSA) Trauma Committee disseminated evidenced-based guidelines to help guide the non-operative management of pediatric blunt solid organ injury. The guidelines significantly contributed to conformity in the management of these patients. Since then, a number of well-designed studies have questioned the strict categorization of these injuries and have led to a renewed reliance on clinical signs of the patient's hemodynamic status. In 2019, APSA introduced an updated set of guidelines emphasizing the use of physiologic status rather than radiologic grade as a driver of clinical decision making for these injuries. This review will focus on liver injuries, in particular blunt injury, as this mechanism is by far the most commonly seen in children. Procedures required when non-operative management fails will be detailed, including surgery, angioembolization, and less commonly employed interventions. Finally, the updated inpatient and post-discharge aspects of care will be reviewed, including hemoglobin monitoring, bedrest, length of hospital stay, and activity restriction.
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Affiliation(s)
- Vincent Duron
- Assistant Professor of Surgery, Division of Pediatric Surgery, Columbia University Vagelos College of Physicians & Surgeons, 3959 Broadway, CHN 215, New York, NY 10032.
| | - Steven Stylianos
- Chief, Division of Pediatric Surgery, Rudolph N Schullinger Professor of Surgery, Columbia University Vagelos College of Physicians & Surgeons, Surgeon-in-Chief, Morgan Stanley Children's Hospital, 3959 Broadway - Rm 204 N, New York, NY 10032.
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9
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Risk factors and management of different types of biliary injuries in blunt abdominal trauma: Single-center retrospective cohort study. ANNALS OF MEDICINE AND SURGERY (2012) 2020. [PMID: 32211187 DOI: 10.1016/j.amsu.2020.02.009.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Biliary injuries after blunt abdominal traumas are uncommon and difficult to be predicted for early management. The aim of this study is to analyze the risk factors and management of biliary injuries with blunt abdominal trauma. Method Patients with blunt liver trauma in the period between 2009 to May 2019 were included in the study. Patients were divided into 2 groups for comparison; a group of liver parenchymal injury and group with traumatic biliary injuries (TBI). Results One hundred and eight patients had blunt liver trauma (46 patients with liver parenchymal injury and 62 patients with TBI). TBI were; 55 patients with bile leak, 3 patients with haemobilia, and 4 patients with late obstructive jaundice. Eight patients with major bile leak and 12 patients with minor bile leak had been resolved with a surgical drain or percutaneous pigtail drainage. Nineteen patients (34.5%) with major and minor bile leak underwent successful endoscopic retrograde cholangiopancreatography (ERCP). Sixteen patients (29.1%) underwent surgical repair for bile leak. In Multivariate analysis, the possible risk factors for prediction of biliary injuries were central liver injuries (P = 0.032), high grades liver trauma (P = 0.046), elevated serum level of bilirubin at time of admission (P = 0.019), and elevated gamma glutamyl transferase (GGT) at time of admission (P = 0.017). Conclusion High-grade liver trauma, central parenchymal laceration and elevated serum level of bilirubin and GGT are possible risk factors for the prediction of TBI. Bile leak after blunt trauma can be treated conservatively, while ERCP is indicated after failure of external drainage.
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Zakaria HM, Oteem A, Gaballa NK, Hegazy O, Nada A, Zakareya T, Omar H, Abdelkawy H, Abdeldayem H, Gad EH. Risk factors and management of different types of biliary injuries in blunt abdominal trauma: Single-center retrospective cohort study. Ann Med Surg (Lond) 2020; 52:36-43. [PMID: 32211187 PMCID: PMC7082429 DOI: 10.1016/j.amsu.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/13/2020] [Accepted: 02/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background Biliary injuries after blunt abdominal traumas are uncommon and difficult to be predicted for early management. The aim of this study is to analyze the risk factors and management of biliary injuries with blunt abdominal trauma. Method Patients with blunt liver trauma in the period between 2009 to May 2019 were included in the study. Patients were divided into 2 groups for comparison; a group of liver parenchymal injury and group with traumatic biliary injuries (TBI). Results One hundred and eight patients had blunt liver trauma (46 patients with liver parenchymal injury and 62 patients with TBI). TBI were; 55 patients with bile leak, 3 patients with haemobilia, and 4 patients with late obstructive jaundice. Eight patients with major bile leak and 12 patients with minor bile leak had been resolved with a surgical drain or percutaneous pigtail drainage. Nineteen patients (34.5%) with major and minor bile leak underwent successful endoscopic retrograde cholangiopancreatography (ERCP). Sixteen patients (29.1%) underwent surgical repair for bile leak. In Multivariate analysis, the possible risk factors for prediction of biliary injuries were central liver injuries (P = 0.032), high grades liver trauma (P = 0.046), elevated serum level of bilirubin at time of admission (P = 0.019), and elevated gamma glutamyl transferase (GGT) at time of admission (P = 0.017). Conclusion High-grade liver trauma, central parenchymal laceration and elevated serum level of bilirubin and GGT are possible risk factors for the prediction of TBI. Bile leak after blunt trauma can be treated conservatively, while ERCP is indicated after failure of external drainage. In most of the published series they discussed the iatrogenic biliary injuries or injuries after sharp trauma. To our knowledge it is the largest series to discuss the biliary injuries with blunt liver trauma. We can predict the possible risk factors for bile duct injury after blunt liver trauma. So we can diagnose and treat it properly and early before sepsis and biliary complications. We can approach to the ideal treatment modality for each type of biliary injuries with prober timing.
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Affiliation(s)
- Hazem M. Zakaria
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Menoufia, Egypt
- Corresponding author. Department of Hepatopancreaticobiliary & liver transplant surgery, National Liver Institute, Menoufia University, 32511, Shebin El-koom, Menoufia, Egypt.
| | - Ahmed Oteem
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Nahla K. Gaballa
- Department of Anesthesiology and Intensive Care, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Osama Hegazy
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Ali Nada
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Talaat Zakareya
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Hazem Omar
- Department of Diagnostic and Intervention Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Hazem Abdelkawy
- Department of Diagnostic and Intervention Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Hesham Abdeldayem
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Emad Hamdy Gad
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Menoufia, Egypt
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11
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Lange B, Adam R, Kähler G, Wessel LM, Kubiak R. Experience with Stent Placement for Benign Pancreaticobiliary Disorders in Children. J Laparoendosc Adv Surg Tech A 2019; 29:839-844. [DOI: 10.1089/lap.2018.0663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Bettina Lange
- Department of Pediatric Surgery, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
| | - Rüdiger Adam
- Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
| | - Georg Kähler
- Department of Central Interdisciplinary Endoscopy, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
| | - Lucas M. Wessel
- Department of Pediatric Surgery, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
| | - Rainer Kubiak
- Department of Pediatric Surgery, Medical Faculty Mannheim, Heidelberg University, University Medical Center, Mannheim, Germany
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12
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Muftah M, Shah R, Fritzen C, Sauer CG, Freeman AJ, Willingham FF. Endoscopic Retrograde Cholangiopancreatography in Pediatric Populations. ACTA ACUST UNITED AC 2019; 17:165-170. [PMID: 30756232 DOI: 10.1007/s11938-019-00225-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Mayssan Muftah
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rushikesh Shah
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Chris Fritzen
- Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Cary G Sauer
- Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Alvin J Freeman
- Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Field F Willingham
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA. .,Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
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13
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Cazauran JB, Muller A, Hengy B, Valette PJ, Gruner L, Monneuse O. Preliminary Report of Percutaneous Cholecystostomy as Diagnosis and Treatment of Biliary Tract Trauma. World J Surg 2018; 42:3705-3714. [PMID: 29882101 DOI: 10.1007/s00268-018-4621-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Biliary leak following severe blunt liver injuries is a complex problem becoming more frequent with improvements in non-operative management. Standard treatment requires main bile duct drainage usually performed by endoscopic sphincterotomy and stent placement. We report our experience with cholecystostomy as a first minimally invasive diagnostic and therapeutic approach. METHODS We performed a retrospective analysis of consecutive patients with post-traumatic biliary leak between 2006 and 2015. In the first period (2006-2010), biliary fistula was managed using perihepatic drainage and endoscopic, percutaneous or surgical main bile duct drainage. After 2010, cholecystostomy as an initial minimally invasive approach was performed. RESULTS Of 341 patients with blunt liver injury, 18 had a post-traumatic biliary leak. Ten patients received standard treatment and eight patients underwent cholecystostomy. The cholecystostomy (62.5%) and the standard treatment (80%) groups presented similar success rates as the first biliary drainage procedure (p = 0.41). Cholecystostomy presented no severe complications and resulted, when successful, in a bile flow rate inversion between the perihepatic drains and the gallbladder drain within a median [IQR] 4 days [1-7]. The median time for bile leak resolution was 26 days in the cholecystostomy group and 39 days in the standard treatment group (p = 0.09). No significant difference was found considering median duration of hospital stay (54 and 74 days, respectively, p = 0.37) or resuscitation stay (17.5 and 19.5 days, p = 0.59). CONCLUSION Cholecystostomy in non-operative management of biliary fistula after blunt liver injury could be an effective, simple and safe first-line procedure in the diagnostic and therapeutic approach of post-traumatic biliary tract injuries.
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Affiliation(s)
- Jean-Baptiste Cazauran
- Département de Chirurgie d'Urgence et de Chirurgie Générale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France
| | - Arnaud Muller
- Département d'Imagerie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Baptiste Hengy
- Département de Réanimation chirurgicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Pierre-Jean Valette
- Département d'Imagerie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Laurent Gruner
- Département de Chirurgie d'Urgence et de Chirurgie Générale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France
| | - Olivier Monneuse
- Département de Chirurgie d'Urgence et de Chirurgie Générale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.
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Wong YC, Wang LJ, Wu CH, Chen HW, Fu CJ, Yuan KC, Lin BC, Hsu YP, Kang SC. Detection and characterization of traumatic bile leaks using Gd-EOB-DTPA enhanced magnetic resonance cholangiography. Sci Rep 2018; 8:14612. [PMID: 30279434 PMCID: PMC6168538 DOI: 10.1038/s41598-018-32976-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023] Open
Abstract
Expanding bile leaks after blunt liver trauma require more aggressive treatment than contained bile leaks. In this retrospective study approved by institution review board, we analyzed if non-invasive contrast-enhanced magnetic resonance cholangiography (CEMRC) using hepatocyte-specific contrast agent (gadoxetic acid disodium) could detect and characterize traumatic bile leaks. Between March 2012 and December 2014, written informed consents from 22 included patients (17 men, 5 women) with a median age of 24.5 years (IQR 21.8, 36.0 years) were obtained. Biliary tree visualization and bile leak detection on CEMRC acquired at 10, 20, 30, 90 minutes time points were independently graded by three radiologists on a 5-point Likert scale. Intraclass Correlation (ICC) was computed as estimates of interrater reliability. Accuracy was measured by area under receiver operating characteristic curves (AUROC). Biliary tree visualization was the best on CEMRC at 90 minutes (score 4.30) with excellent inter-rater reliability (ICC = 0.930). Of 22 CEMRC, 15 had bile leak (8 expanding, 7 contained). The largest AUROC of bile leak detection by three radiologists were 0.824, 0.914, 0.929 respectively on CEMRC at 90 minutes with ICC of 0.816. In conclusion, bile leaks of blunt liver trauma can be accurately detected and characterized on CEMRC.
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Affiliation(s)
- Yon-Cheong Wong
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan. .,Center for Advanced Molecular Imaging and Translation, Taoyuan City, Taiwan.
| | - Li-Jen Wang
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Hsien Wu
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Huan-Wu Chen
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Chen-Ju Fu
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Ching Yuan
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Being-Chuan Lin
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Pao Hsu
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Shih-Ching Kang
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
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Temiz A, Ezer SS, Gedikoğlu M, Serin E, İnce E, Gezer HÖ, Canan MO, Hiçsönmez A. Management of traumatic bile duct injuries in children. Pediatr Surg Int 2018; 34:829-836. [PMID: 29948144 DOI: 10.1007/s00383-018-4295-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
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.
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Affiliation(s)
- Abdulkerim Temiz
- 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.
| | - Semire Serin Ezer
- 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
| | - Murat Gedikoğlu
- Department of Radiology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Adana, Turkey
| | - Ender Serin
- Department of Gastroenterology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Adana, Turkey
| | - Emine İnce
- 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
| | - Hasan Özkan Gezer
- 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
| | - Mehmet Oğuz Canan
- Department of Pediatric Gastroenterology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Adana, Turkey
| | - Akgün Hiçsönmez
- 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
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Aljahdali AH, Murphy JJ. Bile Duct Injury in Children: Is There a Role for Early Endoscopic Retrograde Cholangiopancreatography? Surg J (N Y) 2018; 4:e119-e122. [PMID: 30009264 PMCID: PMC6043242 DOI: 10.1055/s-0038-1665550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 05/16/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction
Liver injury is common among pediatric abdominal trauma. Nonoperative management is the standard of care in isolated stable liver injuries. Bile leak is not an uncommon complication in moderate- and high-grade injuries.
Case series
Three pediatric patients (age: 10–15 years) suffered grade IV liver injuries secondary to blunt abdominal trauma. All developed significant bile leak treated nonoperatively with endoscopic retrograde cholangiopancreatography (ERCP), and patients 1 and 2 were treated with bile duct stent alone. Patient 3 required laparotomy for bile peritonitis and abdominal compartment syndrome followed by interval ERCP and bile duct stent.
Conclusion
Traumatic bile leaks if not recognized and managed early can result in significant morbidity. This paper describes the presentation and treatment of three pediatric patients with blunt liver trauma complicated by significant bile leaks that were managed successfully with ERCP and bile duct stent. This paper demonstrates the importance of early detection of bile leak to prevent bile peritonitis. Abdominal imaging 4 to 5 days postinjury can help in detecting bile accumulation. We believe that ERCP and bile duct stent are becoming the standard of care in diagnosing and treating traumatic bile leak. This paper confirms the safety and feasibility of this technique in the pediatric population.
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Affiliation(s)
- Akram H Aljahdali
- Department of Surgery Johns Hopkins Aramco Healthcare Center, Dhahran, Saudi Arabia
| | - James J Murphy
- Division of Pediatric Surgery, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
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Guanà R, Giulia C, Brunati A, Garofalo S, Schleef J. Biliary Complications after Hepatic Trauma in Children. J Emerg Trauma Shock 2017; 10:211-214. [PMID: 29097861 PMCID: PMC5663141 DOI: 10.4103/jets.jets_136_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim of the Study: In pediatric patients with liver trauma and hemodynamic stability, conservative treatment is acknowledged as the gold standard. Patients and Methods: We conducted a retrospective analysis of 116 consecutive pediatric patients (<14-year-old) observed at our institution for closed abdominal trauma from January 2010 to January 2016. Among these, 16 patients (13%) had hepatic trauma Grade II or more, according to Moore liver trauma injury score. Results: Only one patient underwent surgery for hemodynamic instability; all others children received conservative treatment according to the American Paediatric Surgical Association guidelines. Three patients had a biliary complication (2, 5%). two patients treated surgically by drainage insertion and one was managed conservatively. Conclusions: Biliary complications of liver trauma in children may require aggressive surgical approach in selective patients.
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Affiliation(s)
- Riccardo Guanà
- Division of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Carbonaro Giulia
- Division of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Andrea Brunati
- Division of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Salvatore Garofalo
- Division of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Jurgen Schleef
- Division of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
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Kwatra NS, Sarma A, Lee EY. Practical Indication-Based Pediatric Nuclear Medicine Studies. Radiol Clin North Am 2017; 55:803-844. [DOI: 10.1016/j.rcl.2017.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Kahriman G, Ozcan N, Gorkem SB. Percutaneous management of benign biliary disorders in children. Diagn Interv Imaging 2017. [PMID: 28645679 DOI: 10.1016/j.diii.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The goal of this study was to analyze the outcomes of percutaneous transhepatic management of benign biliary disorders in pediatric patients. MATERIALS AND METHODS This study included 11 pediatric patients who underwent percutaneous transhepatic biliary interventional procedures between September 2007 and December 2016. There were 3 males and 8 females with a mean age of 9.6±5.4 (SD)years (range: 2-17years). Technical details, complications and outcome of the procedures were evaluated. RESULTS The underlying pathologies were bile duct stones (n=2), bile leakage (n=4), choledochal cyst (n=3) and benign biliary stricture (n=2). The therapeutic interventional procedures were as follows; percutaneous stone removal in patients with bile duct stones, external biliary drainage in patients with choledochal cyst, bile diversion by internal-external percutaneous biliary drainage (IE-PBD) in patients with bile leakage, plastic stent placement, IE-PBD with balloon dilatation in patients with benign biliary stricture. The procedures were successful in all patients technically and clinically. One patient experienced intermittent fever. CONCLUSION Percutaneous transhepatic biliary interventional procedure is an effective and safe approach for the treatment of pediatric patients with bile duct stones, bile leakage, symptomatic choledochal cyst and benign biliary stricture when endoscopic procedure is unavailable or fails.
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Affiliation(s)
- G Kahriman
- Erciyes University, Medical Faculty, Gevher Nesibe Hospital, Department of Radiology, 38039 Kayseri, Turkey.
| | - N Ozcan
- Erciyes University, Medical Faculty, Gevher Nesibe Hospital, Department of Radiology, 38039 Kayseri, Turkey.
| | - S B Gorkem
- Erciyes University, Medical Faculty, Gevher Nesibe Hospital, Department of Radiology, 38039 Kayseri, Turkey.
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Koyama T, Skattum J, Engelsen P, Eken T, Gaarder C, Naess PA. Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre. Scand J Trauma Resusc Emerg Med 2016; 24:139. [PMID: 27899118 PMCID: PMC5129239 DOI: 10.1186/s13049-016-0329-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/15/2016] [Indexed: 11/18/2022] Open
Abstract
Background Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and outcomes in children with liver injuries at a major Scandinavian trauma centre over a 12-year period. Methods Patients <17 years old with liver injury admitted to Oslo University Hospital Ullevaal during the period 2002-2013 were retrospectively reviewed. Data were compiled from the institutional trauma registry and medical records. Results A total of 66 children were included. The majority was severely injured as reflected by a median injury severity score of 20.5 (mean 22.2). NOM was attempted in 60 (90.9%) patients and was successful in 57, resulting in a NOM success rate of 95.0% [95% CI 89.3 to 100]. Only one of the three NOM failures was liver related, occurred in the early part of the study period, and consisted in operative placement of drains for bile leak. Two (3.0%) patients underwent angiographic embolization (AE). Complications occurred in 18 (27.3% [95 % CI 16.2 to 38.3]) patients. Only 2 (3.0%) patients had liver related complications, in both cases bile leak. Six (9.1%) patients underwent therapeutic laparotomy for non-liver related injuries. Two (3.0%) patients died secondary to traumatic brain injury. Discussion This single institution paediatric liver injury cohort confirms high attempted NOM and NOM success rates even in patients with high grade injuries and multiple accompanying injuries. AE can be a useful NOM adjunct in the treatment of paediatric liver injuries, but is seldom indicated. Moreover, bile leak is the most common liver-related complication and the need for liver-related surgery is very infrequent. Conclusion NOM is the treatment of choice in almost all liver injuries in children, with operative management and interventional radiology very infrequently indicated.
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Affiliation(s)
- Tomohide Koyama
- Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424, Oslo, Norway.
| | - Jorunn Skattum
- Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424, Oslo, Norway
| | | | - Torsten Eken
- Department of Anesthesiology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424, Oslo, Norway
| | - Pål Aksel Naess
- Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424, Oslo, Norway.,University of Oslo, Oslo, Norway
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Park CI, Park SJ, Lee SB, Yeo KH, Choi SU, Kim SH, Kim JH, Baek DH. Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report. JOURNAL OF TRAUMA AND INJURY 2016. [DOI: 10.20408/jti.2016.29.3.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chan Ik Park
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Sung Jin Park
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Sang Bong Lee
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Kwang Hee Yeo
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Seon Uoo Choi
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Seon Hee Kim
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Jae Hun Kim
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
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Abstract
PURPOSE OF REVIEW Nonoperative management of pediatric blunt abdominal injury has changed significantly in the last few years. RECENT FINDINGS Improved resource utilization in the diagnosis of pediatric abdominal injury has been described. Hemodynamic status, rather than grade of injury, now guides care. Stable patients spend less time in the hospital, return to school upon discharge, and are allowed lower hemoglobin levels prior to transfusion. ICUs are reserved for those with recent or ongoing bleeding, previously unstable patients, or children with concomitant injuries necessitating ICU. Risk factors for failure and evidence for adjuncts to nonoperative management are emerging. Operative management of certain pancreatic injuries may have more favorable outcomes than nonoperative management. SUMMARY Sufficient evidence has become available to radically change the management of pediatric abdominal injury, which is being incorporated into new evidence-based management algorithms.
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Optimizing Human Bile Preparation for Two-Dimensional Gel Electrophoresis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5185317. [PMID: 26966686 PMCID: PMC4757711 DOI: 10.1155/2016/5185317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 12/21/2015] [Indexed: 02/04/2023]
Abstract
Aims. Bile is an important body fluid which assists in the digestion of fat and excretion of endogenous and exogenous compounds. In the present study, an improved sample preparation for human bile was established. Methods and Material. The method involved acetone precipitation followed by protein extraction using commercially available 2D Clean-Up kit. The effectiveness was evaluated by 2-dimensional electrophoresis (2DE) profiling quality, including number of protein spots and spot distribution. Results. The total protein of bile fluid in benign biliary disorders was 0.797 ± 0.465 μg/μL. The sample preparation method using acetone precipitation first followed by 2D Clean-Up kit protein extraction resulted in better quality of 2DE gel images in terms of resolution as compared with other sample preparation methods. Using this protocol, we obtained approximately 558 protein spots on the gel images and with better protein spots presentation of haptoglobin, serum albumin, serotransferrin, and transthyretin. Conclusions. Protein samples of bile prepared using acetone precipitation followed by 2D Clean-Up kit exhibited high protein resolution and significant protein profile. This optimized protein preparation protocol can effectively concentrate bile proteins, remove abundant proteins and debris, and yield clear presentation of nonabundant proteins and its isoforms on 2-dimensional electrophoresis gel images.
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Zundel S, Szavay P. Konservative vs. chirurgische Therapie des Bauchtraumas. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Dalton BGA, Dehmer JJ, Gonzalez KW, Shah SR. Blunt Spleen and Liver Trauma. J Pediatr Intensive Care 2015; 4:10-15. [PMID: 31110844 DOI: 10.1055/s-0035-1554983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Blunt abdominal trauma is an important cause of pediatric morbidity and mortality. The spleen and liver are the most common abdominal organs injured. Trauma to either organ can result in life-threatening bleeding. Controversy exists regarding which patients should be imaged and the correct imaging modality depending on the level of clinical suspicion for injury. Nonoperative management of blunt abdominal trauma is the standard of care for hemodynamically stable patients. However, the optimal protocol to maximize patient safety while minimizing resource utilization is a matter of debate. Adjunctive therapies for pediatric spleen and liver trauma are also an area of ongoing research. A review of the current literature on the diagnosis, management, and follow-up of pediatric spleen and liver blunt trauma is presented.
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Affiliation(s)
- Brian G A Dalton
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - Jeff J Dehmer
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - Katherine W Gonzalez
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - Sohail R Shah
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
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Garvey EM, Haakinson DJ, McOmber M, Notrica DM. Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center. J Pediatr Surg 2015; 50:335-8. [PMID: 25638632 DOI: 10.1016/j.jpedsurg.2014.08.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is no consensus regarding the appropriate use of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric trauma. We report our experience with ERCP for management of pediatric pancreatic and biliary injury following blunt abdominal trauma. METHODS A retrospective chart review was performed for pediatric patients with blunt abdominal trauma from July 2008 through December 2012 at our pediatric trauma center. For patients who underwent ERCP, demographics, injury characteristics, diagnostic details, procedures performed, length of stay, total parenteral nutrition use, and complications were reviewed. RESULTS There were 532 patients identified: 115 hepatic injuries, 25 pancreatic injuries and one gall bladder injury. Nine patients (mean age 7.8 years) underwent ERCP. Seven (78%) had pancreatic injuries, while two (22%) had bilateral hepatic duct injuries. The median time to diagnosis was one day (range, 0-12). Diagnostic ERCP only was performed in three patients, two of which proceeded to distal pancreatectomy. Five patients had stents placed (two biliary and three pancreatic) and four sphincterotomies were performed. Despite pancreatic stenting, one patient required distal pancreatectomy for persistent leak. Median length of stay was 11 days. CONCLUSIONS Pediatric pancreatic and biliary ductal injuries following blunt abdominal trauma are uncommon. ERCP can safely provide definitive treatment for some patients.
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Affiliation(s)
- Erin M Garvey
- Division of General Surgery, The Mayo Clinic, 5777 E Mayo Blvd. Phoenix, AZ 85255 USA
| | - Danielle J Haakinson
- Division of General Surgery, The Mayo Clinic, 5777 E Mayo Blvd. Phoenix, AZ 85255 USA
| | - Mark McOmber
- Pediatric Gastroenterology, Phoenix Children's Hospital, 1920 E Cambridge Ave. Phoenix, AZ 85006 USA
| | - David M Notrica
- Division of General Surgery, The Mayo Clinic, 5777 E Mayo Blvd. Phoenix, AZ 85255 USA; Pediatric Surgery, Phoenix Children's Hospital, 1920 E Cambridge Ave. Phoenix, AZ 85006 USA.
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