title: Treatment and outcome of traumatic biliary injuries in children.
abstract: OBJECTIVE
  Traumatic biliary tract injuries in children are rare but may result in significant morbidity. The objective of this study was to review the occurrence of traumatic biliary tract injuries in children, management strategies, and outcome.
  
  
  METHODS
  We conducted a retrospective review of patients with biliary tract injury using the trauma registry at our level 1 pediatric trauma center from 2002-2012.
  
  
  RESULTS
  Twelve out of 13,582 trauma patients were identified, representing 0.09% of all trauma patients. All were secondary to blunt trauma. Mean age was 9.7 years [range 4-15], and mean Injury Severity Score was 31 ± 14, with overall survival of 92%. Biliary injuries included major ductal injury (6), minor ductal injury with biloma (4), gallbladder injury (2), and intrahepatic ductal injury (1). Major ductal injuries were managed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent (5) and Roux-en-Y hepaticojejunostomy (1). Associated gallbladder injury was managed by cholecystectomy. In addition, the associated biloma was managed with percutaneous drainage (7), laparoscopic drainage (2), or during laparotomy (3). Two patients with ductal injuries developed late strictures after initial management with ERCP and stent placement. One of the two patients ultimately required a left hepatectomy, and the other has been managed conservatively without evidence of cholangitis. Two patients required placement of additional drains and prolonged antibiotics for superinfection following biloma drainage.
  
  
  CONCLUSIONS
  Biliary tract injuries are rare in children, and many are amenable to adjunctive therapy, including ERCP and biliary stent placement with or without placement of a peritoneal drain. Patients with a discrete ductal injury are at higher risk for stricture and require close follow up. Hepaticojejunostomy remains the definitive repair for large extrahepatic biliary tract injuries or transections.
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA. Electronic address: Elizabeth.soukup@imail.org.
authors: Elizabeth S
authors: ES
authors: Soukup
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
authors: Katie W
authors: KW
authors: Russell
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
authors: Ryan
authors: R
authors: Metzger
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
authors: Eric R
authors: ER
authors: Scaife
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
authors: Douglas C
authors: DC
authors: Barnhart
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
authors: Michael D
authors: MD
authors: Rollins
mesh_terms: D000293:Adolescent; D001659:Biliary Tract / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Biliary injury; Gallbladder injury; Hepatobiliary injury; Pediatric trauma