Cay A, Imamoglu M, Ahmetoğlu A, Sarihan H, Calapoğlu A S
Department of Pediatric Surgery, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey.
Eur J Pediatr Surg. 2006 Jun;16(3):205-8. doi: 10.1055/s-2006-924250.
Nonoperative management with close observation represents the standard of care for blunt liver injury, unless vital signs deteriorate or an associated injury requires emergency operation. Injuries of the biliary tract remain important concomitant lesions following liver trauma. Posttraumatic extraductal biliary collections or biliomas are rare complications of blunt abdominal traumas and only a few cases have been reported in the pediatric age group. We report a 5-year-old boy who suffered from blunt abdominal trauma that resulted in liver laceration and, eventually, bilioma formation. The patient was managed nonoperatively for liver injury. The diagnosis was confirmed by computed tomography (CT)-guided needle aspiration and percutaneous catheter drainage, which also allowed nonoperative management. The patient was symptom-free with normal liver function tests and a normal liver appearance on ultrasound examination six months after the accident. The possibility of missed bile duct injury should be considered when nonoperative management is used and close observation of the patient is necessary over a prolonged period.
除非生命体征恶化或存在需要紧急手术的相关损伤，否则密切观察下的非手术治疗是钝性肝损伤的标准治疗方法。胆道损伤仍然是肝外伤后重要的伴随病变。创伤后肝外胆管积液或胆汁瘤是钝性腹部创伤的罕见并发症，儿科年龄组仅有少数病例报道。我们报告一名5岁男孩，他遭受钝性腹部创伤，导致肝撕裂伤，最终形成胆汁瘤。该患者肝损伤采用非手术治疗。通过计算机断层扫描（CT）引导下的针吸活检和经皮导管引流确诊，这也使得非手术治疗成为可能。事故发生六个月后，患者无症状，肝功能检查正常，超声检查肝脏外观正常。采用非手术治疗时应考虑漏诊胆管损伤的可能性，并且需要对患者进行长期密切观察。
