Gallegos Chavez Diego F, Udaquiola Julia E, Vagni Roberto L, Lobos Pablo, Moldes Juan M, Liberto Daniel H
Servicio de Cirugía y Urología Pediátrica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
Arch Argent Pediatr. 2018 Dec 1;116(6):e778-e781. doi: 10.5546/aap.2018.e778.
Hepatic and biliary tract injuries due to traumatic causes are rare in pediatric patients. Of the total number of patients with closed abdominal trauma, less than 9 % have liver injury, and the frequency varies between 2 and 3 % of biliary tract lesions. Currently, the recommended treatment for closed abdominal trauma with liver injury without hemodynamic repercussion is conservative. In case of presenting intra or extrahepatic biliary tract lesion, the preferred approaches are minimally invasive, such as percutaneous or endoscopic surgery, using laparotomy in selected cases. We present the case of a patient with closed abdominal trauma and liver trauma, initially laparotomized on 2 occasions due to hemodynamic instability and hemoperitoneum; presented a subdiaphragmatic and coleperitoneal bilioma; it was performed minimally invasive percutaneous drainage under tomographic control.
创伤性肝和胆道损伤在儿科患者中很少见。在所有闭合性腹部创伤患者中，肝损伤患者不到9%，胆道损伤的发生率在2%至3%之间。目前，对于无血流动力学影响的闭合性腹部创伤合并肝损伤，推荐的治疗方法是保守治疗。如果出现肝内或肝外胆道损伤，首选的方法是微创治疗，如经皮或内镜手术，在某些特定情况下采用剖腹手术。我们报告一例闭合性腹部创伤合并肝损伤患者的病例，该患者最初因血流动力学不稳定和腹腔积血接受了两次剖腹手术；出现了膈下和结肠周围胆汁瘤；在断层扫描控制下进行了微创经皮引流。
