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Endoscopic management of traumatic hepatobiliary injuries
Author(s) -
Singh Virendra,
Narasimhan Kannan Laksmi,
Verma Ganga Ram,
Singh Gurpreet
Publication year - 2007
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2006.04780.x
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , surgery , biliary fistula , fistula , bile duct , endoscopy , pancreatitis
Background: Non‐surgical treatment has become the therapeutic method of choice in hemodynamically stable patients with liver trauma. There are a few reports of endoscopic management of traumatic hepatobiliary injuries in such patients; however, the optimal intervention is not known. Methods: Twenty patients with traumatic hepatobiliary injuries from May 1997 to November 2005 were retrospectively evaluated. Results: There were 18 male and two female patients with a mean age of 21.45 ± 10.17 years (range 7–42 years). Seven patients were children. Patients presented 19.4 ± 17.04 days following trauma. Computed tomography (CT) revealed hepatic laceration in right lobe in 14 (70%) and in left lobe in six (30%) patients. Endoscopic retrograde cholangiopancreatography (ERCP) revealed biliary leak in right duct in 14 (70%) and in left duct in six (30%) patients. Five patients also had bilhemia and one had hemobilia. Thirteen patients (65%) were treated by endoscopic sphincterotomy with nasobiliary drainage and seven (35%) were treated by nasobiliary drainage alone, which enabled fistula closure in 15.76 ± 4.22 days and 12.14 ± 3.93 days, respectively ( P > 0.05). One patient in sphincterotomy group died due to multiple bony injuries and fat embolism. Two patients developed fever following ERCP, which responded to antibiotic treatment. Conclusions: Endoscopic treatment with nasobiliary drainage without sphincterotomy is the optimal method of management of traumatic hepatobiliary injuries in hemodynamically stable patients.