PMID- 24650470
OWN - NLM
STAT- MEDLINE
DCOM- 20141126
LR  - 20220331
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Linking)
VI  - 49
IP  - 3
DP  - 2014 Mar
TI  - Traumatic bile leaks from blunt liver injury in children: a multidisciplinary and 
      minimally invasive approach to management.
PG  - 424-7
LID - S0022-3468(13)00645-3 [pii]
LID - 10.1016/j.jpedsurg.2013.07.015 [doi]
AB  - BACKGROUND: Selective non-operative management (NOM) of hemodynamically stable 
      pediatric patients with blunt hepatic trauma is the standard of care. Traumatic 
      bile leaks (TBL) are a potential complication following liver injury. The use of 
      endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and 
      treatment of TBL is described in adults, but limited in the pediatric literature. 
      We report our experience with a multidisciplinary and minimally invasive approach 
      to the management of TBL. METHODS: This was an IRB-approved 13-year retrospective 
      review (January 1999-December 2012) of an institutional pediatric trauma 
      registry; 294 patients (</= 17 years old) sustained blunt hepatic injury. Those 
      with TBL were identified. Patient demographics, mechanism of injury, management 
      strategy and outcomes were reviewed. RESULTS: Eleven patients were identified 
      with TBL. Hepatobiliary iminodiacetic scan (HIDA) was diagnostic. Combinations of 
      peri-hepatic drain placement, ERCP with biliary stenting and/or sphincterotomy 
      were performed with successful resolution of TBL in all cases. No child required 
      surgical repair or reconstruction of the leak. Cholangitis developed in one 
      child. There were no long-term complications. CONCLUSIONS: A multidisciplinary 
      and minimally invasive approach employing peri-hepatic external drainage 
      catheters and ERCP with sphincterotomy and stenting of the ampulla is a safe and 
      effective management strategy for TBL in children.
CI  - (c) 2014.
FAU - Kulaylat, Afif N
AU  - Kulaylat AN
AD  - Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA 
      17033, USA.
FAU - Stokes, Audrey L
AU  - Stokes AL
AD  - Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA 
      17033, USA.
FAU - Engbrecht, Brett W
AU  - Engbrecht BW
AD  - Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, 
      PA 17033, USA.
FAU - McIntyre, J Steele
AU  - McIntyre JS
AD  - Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA 
      17033, USA.
FAU - Rzucidlo, Susan E
AU  - Rzucidlo SE
AD  - Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, 
      PA 17033, USA.
FAU - Cilley, Robert E
AU  - Cilley RE
AD  - Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, 
      PA 17033, USA. Electronic address: rcilley@hmc.psu.edu.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
RN  - 0 (Radiopharmaceuticals)
RN  - 6433TZJ6TQ (Technetium Tc 99m Lidofenin)
SB  - IM
MH  - Adolescent
MH  - Ampulla of Vater
MH  - *Bile
MH  - Bile Ducts/diagnostic imaging/*injuries/surgery
MH  - Child
MH  - Child, Preschool
MH  - *Cholangiopancreatography, Endoscopic Retrograde
MH  - Female
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Liver/diagnostic imaging/*injuries/surgery
MH  - Male
MH  - Minimally Invasive Surgical Procedures
MH  - Radionuclide Imaging
MH  - Radiopharmaceuticals
MH  - Retrospective Studies
MH  - Sphincterotomy, Endoscopic
MH  - Stents
MH  - Suction
MH  - Technetium Tc 99m Lidofenin
MH  - Wounds, Nonpenetrating/diagnostic imaging/surgery/*therapy
OTO - NOTNLM
OT  - Bile leak/injury
OT  - Blunt trauma
OT  - Endoscopic retrograde cholangiopancreatography (ERCP)
OT  - Liver trauma/injury
OT  - Non-operative management
OT  - Pediatric
EDAT- 2014/03/22 06:00
MHDA- 2014/12/15 06:00
CRDT- 2014/03/22 06:00
PHST- 2013/04/10 00:00 [received]
PHST- 2013/07/24 00:00 [revised]
PHST- 2013/07/28 00:00 [accepted]
PHST- 2014/03/22 06:00 [entrez]
PHST- 2014/03/22 06:00 [pubmed]
PHST- 2014/12/15 06:00 [medline]
AID - S0022-3468(13)00645-3 [pii]
AID - 10.1016/j.jpedsurg.2013.07.015 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2014 Mar;49(3):424-7. doi: 10.1016/j.jpedsurg.2013.07.015.