Definitive treatment of traumatic biliary injuries.
BACKGROUND
We presented our experience with definitive treatment of traumatic biliary injuries.


METHODS
Six male patients (mean age 13 years; range 2 to 32 years) who were referred to our unit for definitive treatment of traumatic biliary injuries were retrospectively evaluated. Data were analyzed in terms of demographic characteristics, mechanisms of injuries, associated injuries, previous treatments, symptoms on admission, treatment at our unit, and the results of treatment. Outcome was assessed using modified Schweiser and Blumgart criteria.


RESULTS
The injuries were due to blunt abdominal trauma in all the patients but one who had a gunshot wound. In three patients, biliary injuries were missed at the initial operation. On admission, three patients had external biliary fistulas, two had biliary strictures. One patient was sent following inadvertent ligation of the hepatoduodenal ligament during attempts to control hemorrhage. Roux-en-Y hepaticojejunostomy was performed in three patients. Percutaneous biloma drainage was performed in two patients, resulting in fistula closure in 13 and 40 days, respectively. One patient was treated by endoscopic retrograde cholangiopancreatography and papillotomy, which enabled fistula closure in three days. One patient was lost to follow-up. One patient died from hepatic failure 11 years after the trauma. At the end of a mean follow-up of 49 months (range 15 to 75 months), three patients were in excellent condition, while one patient experienced occasional attacks of cholangitis.


CONCLUSIONS
In patients with undetected biliary injuries and in those with unsuccessful repair attempts, biliary reconstruction should be performed in experienced hepatopancreatobiliary surgery units.
Erkan
Mert
M
Department of General Surgery, Hepatopancreatobiliary Surgery Unit, Medicine Faculty of Istanbul, Istanbul, Turkey.
Bilge
Orhan
O
Ozden
Ilgin
I
Tekant
Yaman
Y
Acarli
Koray
K
Alper
Aydin
A
Emre
Ali
A
Arioğul
Orhan
O
D000293:Adolescent; D000328:Adult; D001658:Biliary Fistula / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries* / Q000601:surgery; D008297:Male; D008499:Medical Records; D011183:Postoperative Complications; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000209:etiology / Q000601:surgery