Benefits of early diagnosis and preemptive treatment of biliary tract complications after major blunt liver trauma in children.
OBJECTIVE
Nonoperative management of blunt liver trauma may delay diagnosis of related biliary complications leading to delayed surgical intervention and related morbidity. The aim of this study was to see whether technetium (tc) 99 trimethylbromo-im-indolacetic acid (TBIDA) nuclear scan would allow noninvasive early diagnosis of bile leak and pre-emptive management.


METHODS
Retrospective analysis of the patient records and radiologic investigations of 7 patients admitted between April 1998 and December 2000 with "major" blunt liver trauma (parenchymal fracture of less than 4 cm on computed tomography [CT] scan or involving porta hepatis) and various types of biliary complications. Patients with or without early TBIDA diagnosis were compared.


RESULTS
There were 7 patients. The first 2 patients were treated conventionally without TBIDA, and late diagnosis was associated with further related problems (sepsis, life-threatening hemorrhage in both cases) and prolonged hospital stay. The subsequent 5 consecutive patients benefited from early diagnosis (TBIDA scan, 2 to 4 days after trauma), and preemptive management was done (tailored to each case). There was no further or related morbidity. All 7 patients currently are alive and well.


CONCLUSIONS
A TBIDA nuclear medicine scan was efficient in providing an early diagnosis of biliary leakage, thus, allowing adequate preemptive management. In turn, this may have helped avoid related added morbidity compared with cases of late diagnosis. Early TBIDA scan should be performed routinely when the initial CT scan confirms liver trauma graded as "major."
Paediatric Liver Unit and Departments of Radiology and General Paediatric Surgery, Birmingham Children's Hospital, Birmingham, England.
K
K
Sharif
A P
AP
Pimpalwar
P
P
John
K
K
Johnson
S
S
Donnell
J
J
De Ville De Goyet
D000293:Adolescent; D000814:Aniline Compounds; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000293:injuries*; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D002648:Child; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications*
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; C034837:technetium Tc 99m mebrofenin; D005998:Glycine