Management of traumatic bile duct injuries in children

• Published in: Pediatric surgery international Vol. 34; no. 8; pp. 829 - 836
• Main Authors: Temiz, Abdulkerim, Ezer, Semire Serin, Gedikoğlu, Murat, Serin, Ender, İnce, Emine, Gezer, Hasan Özkan, Canan, Mehmet Oğuz, Hiçsönmez, Akgün
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2018; Springer Nature B.V
• Subjects: Bile; Injuries; Medicine; Medicine & Public Health; Original Article; Patients; Pediatric Surgery; Pediatrics; Surgery; Bile leakage; Cholangiography; Endoscopic treatment; Injury; Biliary
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-018-4295-4

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.