title: Endoscopic management of traumatic hepatobiliary injuries.
abstract: BACKGROUND
  Non-surgical treatment has become the therapeutic method of choice in hemodynamically stable patients with liver trauma. There are a few reports of endoscopic management of traumatic hepatobiliary injuries in such patients; however, the optimal intervention is not known.
  
  
  METHODS
  Twenty patients with traumatic hepatobiliary injuries from May 1997 to November 2005 were retrospectively evaluated.
  
  
  RESULTS
  There were 18 male and two female patients with a mean age of 21.45 +/- 10.17 years (range 7-42 years). Seven patients were children. Patients presented 19.4 +/- 17.04 days following trauma. Computed tomography (CT) revealed hepatic laceration in right lobe in 14 (70%) and in left lobe in six (30%) patients. Endoscopic retrograde cholangiopancreatography (ERCP) revealed biliary leak in right duct in 14 (70%) and in left duct in six (30%) patients. Five patients also had bilhemia and one had hemobilia. Thirteen patients (65%) were treated by endoscopic sphincterotomy with nasobiliary drainage and seven (35%) were treated by nasobiliary drainage alone, which enabled fistula closure in 15.76 +/- 4.22 days and 12.14 +/- 3.93 days, respectively (P > 0.05). One patient in sphincterotomy group died due to multiple bony injuries and fat embolism. Two patients developed fever following ERCP, which responded to antibiotic treatment.
  
  
  CONCLUSIONS
  Endoscopic treatment with nasobiliary drainage without sphincterotomy is the optimal method of management of traumatic hepatobiliary injuries in hemodynamically stable patients.
authors: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. virendrasingh100@hotmail.com
authors: Virendra
authors: V
authors: Singh
authors: Kannan Laksmi
authors: KL
authors: Narasimhan
authors: Ganga Ram
authors: GR
authors: Verma
authors: Gurpreet
authors: G
authors: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D001659:Biliary Tract / Q000293:injuries*; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008099:Liver / Q000293:injuries*; D008297:Male; D016717:Sphincterotomy, Endoscopic