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Bile fistula after penetrating hepatic trauma with expectant management in the “era” of endoscopic treatment: Hospital General Regional No. Instituto Mexicano del Seguro Social. Calle de los AlamosFraccionamiento Los Alamos. Conventional treatment has consisted of surgical intervention with hepatic debridement, ductal repair, controlled drainage and ERCP when available. Heridas por arma de fuego. Bile fistula is a rare cause of major morbidity after major hepatic trauma, corresponding to 0.

Furthermore, bile retention in the necrotic space leads to the development of the intraperitoneal septic complications that are known to be a cause of dead.

herida punzocortante

Bile leakage is defined as continuous biliary discharge from drainage ducts punzocrotantes of its bilirubin concentrations or delayed biliary fluid collection bilomaat the scar surface of the liver, with the patient having clinical symptoms such as fever, pleural effusion, or an elevated serum C-reactive protein level after removing the drainage tubes 3.

A bile fistula may develop following hepatic trauma, as higher pressures in the biliary system make to easier for bile to flow into injured area than to duodenum 4.

The Endoscopic Retrograde Cholangio Pancreatography ERCP is indicated to identify obstruction, and as a rule endoscopic sphinterotomy promotes healing, when fistula not responding have been successfully treated by placing an endoprosthesis.

Punzocortantrs, ERCP is both diagnostic and therapeutic tool for the safe puunzocortantes of biliary ductal injury after severe liver trauma 5.

But, if this tool is not available in our setting? We evaluated a patient presenting early after liver penetrating trauma with bile leakage in whom the geridas of fistula was the orifice of gunshot trauma. We discuss the value of the approach and expectant management of this condition.


A 28 years-old man was admitted to emergency room with thoracic-abdominal penetrating gunshot trauma. The patient was hemodynamically unstable, the Pringle maneuver was done and we tried to repair the hepatic injury.

Heridas por Arma blanca by Irene Mora on Prezi

However, the injured area was in a continuous bleeding so abbreviated surgery, a damage control surgery, was done; the hepatic areas was packaged and superficial layers closed. The patient was send to intensive care unit. At day 1 after damage control surgery, the patient was stable and we decided make relaparotomy, we found necrotic tissue and no herdas bleeding, however a biliary leakage was observed.

We tried to repair the area and necrotic tissue was debrided. An open Penrose drain heridaz inserted close to injured area. The package was retired and the abdominal wall closed using mass technique.

Although ERCP is used for definitive treatment in posttraumatic bile fistula, lack of this tool forced us to decided expectant management and wait the healing tissue to close the fistula. After a full expansion of the right lung, the chest drain was removed on day 6.

Herida por arma blanca

Right peri-hepatic hematoma, right biloma, and right pleural effusion were reported in computer tomography at day 22 See figure 2right inferior thoracotomy was performed at day No bile leakage to pleural space was detected, and pleural drain was inserted to re-expand the lung after thoracic surgery.

Clinical follow-up has heriras continued for 2 months without any complaint. Biliary leakage was not common, in our review of 86 patients with hepatic penetrating trauma we hheridas not found any biliary fistula 6.

punzocortantea Posttraumatic bile leaks may present either as bile peritonitis or as a bile lead through a drain site like our patient 7. Although earlier studies showed that the majority of complications following liver trauma can be successfully managed with percutaneous drainage 8safety of endoscopic management is the gold standard currently 9.


But in developing countries, with lack of many diagnostic and therapeutic tools, expectant management in patients with biliary fistula continues like an efficient tool in the patient with severe liver trauma. The median for bile leak closed spontaneously is days 7,8our patient had 35 days to closed biliary leakage.

Although, no mortality is reported due to biliary leakage, all complications reflect the severity herdias the initial injury rather than the bile leak 7,8. Although endoscopic sphincterotomy is a reliable and effective therapeutic, in management in patients with external biliary fistulas 10, Patients in hospitals without this tool, expectant management with percutaneous drainage remains like an effective and safe conduct. Written informed consent was obtained from the patient punzocorrtantes publications of this case report and accompanying images.

A copy of the written consent is available for review by the Editor-in-Chief of this journal. Current treatment of hepatic trauma.

Herida por arma blanca – Wikipedia, la enciclopedia libre

Management of liver trauma in consecutive patients. Effectiveness of endoscopic nasobiliary drainage for postoperative bile neridas after hepatic resection. Successful treatment of postoperative external biliary fistula by selective nasobiliary drainage. Biliary fistulas resulting from blunt hepatic injury treated by endoscopic diversion of the bile flow. Biloma and biliary fistula following hepatorraphy for liver trauma: Management of biliary complications following damage punzlcortantes surgery for liver trauma.

Eur J Trauma Emerg Surg. Successful treatment of postoperative external biliary fistulas by endoscopic sphincterotomy.

Current Management of hepatic trauma. Surg Clin North Am. Services on Demand Article. English heridqs Article in xml format Article references How to cite this article Automatic translation Send this article by e-mail. How to cite this article.