Major intrahepatic bile duct injuries detected after laparotomy: selective nonoperative management.
BACKGROUND
Abdominal trauma causing major intrahepatic bile duct injury is a relatively uncommon occurrence. Most authorities recommend operative, usually resectional, management of these injuries when recognized, citing increased risks of complications and mortality with nonoperative management. However, very few data have been published to document the optimal management of these challenging injuries.


METHODS
We present a series of five patients with significant hepatic injury and documented major bile duct injury managed at a single provincial trauma center. All of these patients had first- or second-order bile duct injuries diagnosed using endoscopic retrograde cholangiopancreatography and had developed complications caused by the ductal injury.


RESULTS
In all patients, the bile duct injury and resulting complication were successfully managed by a combination of endoscopic drainage procedures and interventional radiology techniques. Average length of hospital stay for these patients was 45 days. All patients eventually attained preinjury functional status.


CONCLUSIONS
Nonoperative techniques can be used to successfully manage selected patients and represent a reasonable alternative to operative intervention and resectional therapy, especially in the compromised patient. Extended length of stay is to be expected, but good outcomes can be achieved.
Division of General Surgery, University of BC, Vancouver, British Columbia, Canada.
S K
SK
D'Amours
R K
RK
Simons
C H
CH
Scudamore
A G
AG
Nagy
D R
DR
Brown
D000293:Adolescent; D000328:Adult; D001653:Bile Ducts, Intrahepatic / Q000293:injuries*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D018579:Patient Selection; D015641:Radiography, Interventional / Q000379:methods*; D020127:Recovery of Function; D015607:Stents; D016896:Treatment Outcome