Nonoperative management of blunt extrahepatic biliary duct transection in the pediatric patient: Case report and review of the literature

Penetrating Bile Duct Injury

“…Gradual appearance of ascites with jaundice, associated with normal liver functions, nondilated biliary tree on ultrasound and proximity of trauma to the liver and duodenum, justify HIDA scan for leak search [3,4]. In our case, the clinical picture suggestive of bile leak appeared only on day 5 after trauma.…”

“…Injury to the extrahepatic biliary tree is rare in the pediatric population and more often associated with blunt abdominal trauma [4]. Pediatric bile duct injury following penetrating trauma of different kinds is scantly described in the literature [8].…”

“…In missed cases (either blunt or penetrating trauma), it takes several days for clear clinical symptoms to appear [3,4]. Gradual appearance of ascites with jaundice, associated with normal liver functions, nondilated biliary tree on ultrasound and proximity of trauma to the liver and duodenum, justify HIDA scan for leak search [3,4].…”

“…Missed bile duct injury discovered several days after the event, represents a serious dilemma for the surgeon [1][2][3]. Recently, endoscopic retrograde cholangiopancreatography (ERCP) has become an excellent alternative for the management of such cases [4][5][6][7].…”

Packing to Tamponade Severe Intracranial Hemorrhage in Pediatric Patients

“…Stylianos [17 ]reported the effectiveness of abdominal packing for severe hemorrhage in refractory abdominal and retroperitoneal sites and in hepatic hemorrhage in pediatric patients. Other situations in which packing has been used to effectively tamponade severe hemorrhage in adults include thoracic hemorrhage [18,19], facial trauma [20], pelvic fractures [21,22,23], abdominal trauma [24], liver trauma [25], maxillofacial trauma [26], and postpartum hemorrhage [27]. …”