Akademik Veri Yönetim Sistemi
Cocuk Cerrahisi Dergisi, cilt.19, sa.2, ss.88-91, 2005 (Scopus)
Introduction: If blunt liver trauma results in a passage between the biliary tract and blood vessels, there will be either a flow of blood into the bile ducts (hemobilia) or of bile into the bloodstream (bilhemia). We present a case of posttraumatic bilhemia treated with nonoperative interventional techniques. Case: 10-year-old boy with jaundice and abdominal pain after a bicycle accident was explored in another hospital; laceration of the falciform ligament and subcapsular liver hematoma were detected. Because of persistent increase of total bilirubin level, the patient was referred to our clinic. Physical examination findings were only abdominal tenderness and jaundice on admission. Ultrasonography and computerized tomography revealed laceration at the porta hepatis level and intraabdominal free fluid. Hepatobiliary scintigraphic findings were accumulation of activity in the localization of left hepatic duct and extrahepatic appearance of radionuclide with absence of passage of bile through intestine. Endoscopic retrograde cholangiography showed tear of the left hepatic duct and extravasation of radioopaque material; decompressive sphincterotomy was performed, however stenting of the bile duct could not be achieved. This intervention resulted in a transient decrease of bilirubin level, but due to re-increase in the bilirubin levels percutaneous transhepatic cholangiography (PTC) was performed. PTC showed transection of intrahepatic bile ducts and bile leak through venous system by biliovenous fistula. A drainage catheter was placed in the left intrahepatic bile duct. As bile drainage decreased, control pouchography with radioopaque revealed no biliary leak and normal bile flow, the catheter was removed. The patient was discharged with normal bilirubin levels. Conclusion: Previous reports have described different surgical treatment modalities, such as liver resection and fistula repair. Recent advances in interventional radiology and endoscopy make minimal invasive management of bilhemia possible. If endoscopic sphincterotomy with stenting of the biliary ducts is not possible, percutaneous drainage can be an alternative treatment.