Abstract
Background: Bile duct injury after blunt abdominal trauma is a rare entity in the pediatric population. Its occurrence has been highly linked to the primary injuries of the liver or duodenum as explained by their anatomical affiliation.
Case presentation: Here we present a case of a 4-year-old female brought in with a history of generalized abdominal pain that was associated with distension and absolute constipation. This was preceded by a blunt abdominal traumatic incident four days prior. On examination, she was ill-looking, tachypneic, and had a grossly distended abdomen with a positive Blumberg's sign. After the baseline laboratory and radiographic investigations, she was taken for exploration where Bile peritonitis was found secondarily to a perforated common bile duct (CBD). All other visceral structures and organs were fine; a meticulous primary closure of the 2 by 1 cm defect was done as superimposed by an omental patch. She fared well post-operatively and was discharged on the seventh day.
Conclusion: Though rare, biliary tract injury should always be considered among the differential diagnoses in blunt abdominal trauma, as its early diagnosis precipitates early intervention which will in turn positively affect the patient's outcome.
Downloads
References
- Zakaria HM, Oteem A, Gaballa NK, Hegazy O, Nada A, Zakareya T, et al. Risk factors and management of different types of biliary injuries in blunt abdominal trauma: single-center retrospective cohort study. Ann Med Surg (Lond). 2020 Apr;52:36-43. doi:10.1016/j.amsu.2020.02.016.
- Matesan M, Bermo M, Cruite I, Shih CH, Elojeimy S, Behnia F, et al. Biliary leak in the postsurgical abdomen: a primer to HIDA scan interpretation. Semin Nucl Med. 2017 Nov;47(6):618-629. doi:10.1053/j.semnuclmed.2017.07.003.
- Young M, Mehta D. Percutaneous Transhepatic Cholangiogram. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jul 25. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537010/
- Aljahdali AH, Murphy JJ. Bile duct injury in children: is there a role for early endoscopic retrograde cholangiopancreatography? Surg J (N Y). 2018 Jul;4(3):e119-e122. doi:10.1055/s-0038-1660844.
- Strazzabosco M, Fabris L. Functional anatomy of normal bile ducts. Anat Rec (Hoboken). 2008 Jun;291(6):653-660. doi:10.1002/ar.20685.
- Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients: results of a prospective trial. Ann Surg. 1995 Jun;221(6):744-53. doi:10.1097/00000658-199506000-00015.
- Moulton SL, Downey EC, Anderson DS, Lynch FP. Blunt bile duct injuries in children. J Pediatr Surg. 1993 Jun;28(6):795-7. doi:10.1016/s0022-3468(05)80146-8.
- Le MT, Herrmann J, Groth M, Reinshagen K, Boettcher M. Traumatic gallbladder perforation in children–case report and review. Rofo. 2021 Aug;193(8):889-97. doi:10.1055/a-1285-8031.
- Temiz A, Ezer SS, Gedikoğlu M, Serin E, İnce E, Gezer HÖ, et al. Management of traumatic bile duct injuries in children. Pediatr Surg Int. 2018 Aug;34(8):829-36. doi:10.1007/s00383-018-4298-8.
- Hopfer K, Ziessman H. Nuclear medicine hepatobiliary imaging (cholescintigraphy). Gastrointest Endosc. 2011 Aug;74(2):375-7. doi:10.1016/j.gie.2011.01.037.
- Lambie H, Cook AM, Scarsbrook AF, Lodge JP, Robinson PJ, Chowdhury FU. Tc99m-hepatobiliary iminodiacetic acid (HIDA) scintigraphy in clinical practice. Clin Radiol. 2011 Nov;66(11):1094-105. doi:10.1016/j.crad.2011.07.002.
- Wahl WL, Brandt MM, Hemmila MR, Arbabi S. Diagnosis and management of bile leaks after blunt liver injury. Surgery. 2005 Oct;138(4):742-8. doi:10.1016/j.surg.2005.07.027.
- Kröner PT, Bilal M, Samuel R, Umar S, Abougergi MS, Lukens FJ, et al. Use of ERCP in the United States over the past decade. Endosc Int Open. 2020 Jun;8(6):E761-9. doi:10.1055/a-1156-3870.
- Solomon S, Baillie J. Indications for and contraindications to ERCP. In: ERCP. Elsevier; 2019. p. 54-8. ISBN: 9780323642760.
- Lewey S, Adler DG. Fundamentals of ERCP image interpretation. Pract Gastroenterol. 2023 Aug;47(8):21.
- Aduna M, Larena JA, Martin D, Martínez-Guereñu B, Aguirre I, Astigarraga E. Bile duct leaks after laparoscopic cholecystectomy: value of contrast-enhanced MRCP. Abdom Imaging. 2005 Aug;30:480–7. doi:10.1007/s00261-004-0210-6.
- Chandel K, Patel RK, Tripathy T, Mukund A, Chauhan NS, Kumar C, et al. Transhepatic cholangiography and biliary drainage: basic concepts and technique. Dig Dis Interv. 2024 Oct 16. (Early Online). doi:10.1055/s-0044-1782347.
- Venkatanarasimha N, Damodharan K, Gogna A, Leong S, Too CW, Patel A, et al. Diagnosis and management of complications from percutaneous biliary tract interventions. Radiographics. 2017 Mar;37(2):665-80. doi:10.1148/rg.2017160141.
- LeBedis CA, Bates DD, Soto JA. Iatrogenic, blunt, and penetrating trauma to the biliary tract. Abdom Radiol (NY). 2017 Jan;42(1):28-45. doi:10.1007/s00261-016-0885-0.
- Schreuder AM, Busch OR, Besselink MG, Ignatavicius P, Gulbinas A, Barauskas G, et al. Long-term impact of iatrogenic bile duct injury. Dig Surg. 2020;37(1):10-21. doi:10.1159/000501092.
