Aljahdali Akram H, Murphy James J
Department of Surgery Johns Hopkins Aramco Healthcare Center, Dhahran, Saudi Arabia.
Division of Pediatric Surgery, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont.
Surg J (N Y). 2018 Jul 12;4(3):e119-e122. doi: 10.1055/s-0038-1665550. eCollection 2018 Jul.
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. 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. 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.
肝损伤在小儿腹部创伤中很常见。非手术治疗是单纯稳定型肝损伤的标准治疗方法。胆汁漏在中、重度损伤中是一种常见的并发症。
三名儿科患者（年龄：10 - 15岁）因钝性腹部创伤导致IV级肝损伤。所有患者均出现明显胆汁漏，采用内镜逆行胰胆管造影术（ERCP）进行非手术治疗，患者1和患者2仅接受胆管支架置入治疗。患者3因胆汁性腹膜炎和腹腔间隔室综合征接受剖腹手术，随后进行间隔性ERCP和胆管支架置入。
外伤性胆汁漏如果未被早期识别和处理，可能导致严重的发病率。本文描述了三名小儿钝性肝创伤合并明显胆汁漏患者的临床表现及治疗情况，这些患者通过ERCP和胆管支架置入成功治愈。本文证明了早期发现胆汁漏以预防胆汁性腹膜炎的重要性。受伤后4至5天的腹部影像学检查有助于发现胆汁积聚。我们认为ERCP和胆管支架置入正成为诊断和治疗外伤性胆汁漏的标准治疗方法。本文证实了该技术在儿科人群中的安全性和可行性。
