ABSTRACT
Objetivo: Reportar un caso clínico de lesión de la vía biliar intrapancreática tras traumatismo abdominal cerrado. Caso clínico: Paciente que acude a urgencias por intenso dolor abdominal, tras sufrir traumatismo toraco-abdominal cerrado al caer de una bicicleta. Posteriormente a su ingreso desarrolló fiebre, ictericia y patrón analítico de colestasis. Se solicitó colangiorresonancia magnética donde no se pudo valorar correctamente la vía biliar, pero se evidenció abundante líquido intraabdominal que no correspondía a sangre. Se indicó cirugía urgente ante la sospecha de lesión biliar. Se objetivó lesión de la vía biliar intrapancreática mediante colangiografía intra-operatoria y se decidió colocación de prótesis intrabiliar mediante colangiopancreatografía retrógrada endoscópica (CPRE) intraoperatoria. Conclusión: La cirugía ha sido el tratamiento convencional para la lesión de la vía biliar, pero en la actualidad la CPRE con esfinterotomía y colocación de prótesis intrabiliar es un tratamiento adecuado y resolutivo de este tipo de lesiones pudiéndose considerar como tratamiento de primera línea.
Aim: To report a clinical case of biliar injury intrapancreatic in closed abdominal trauma. Clinical case: Patient who comes to the emergency room by severe abdominal pain after suffering thoraco-abdominal blunt trauma after falling from a bicycle. After his admission he developed fever, jaundice and analytical standards of cholestasis. Magnetic resonance which failed to correctly assess the bile duct was requested but showed plenty of intra-abdominal fluid blood that did not match. Emergency surgery for suspected biliary injury was reported. Intrapancreatic injury bile duct was observed by intraoperative cholangiography and prosthesis was decided intrabiliary by intraoperative endoscopic retrograde cholangiopancreatography (ERCP). Conclusions: Surgery has been the standard treatment for bile duct injury, but now ERCP with sphincterotomy and placement of intrabiliary prosthesis is adequate and operative treatment of these injuries and can be considered as first-line treatment.
Subject(s)
Humans , Male , Middle Aged , Pancreas/injuries , Bile Ducts/surgery , Bile Ducts/injuries , Cholangiopancreatography, Endoscopic Retrograde , Abdominal Injuries/complications , Prostheses and Implants , Wounds, Penetrating/surgery , Wounds, Penetrating/complications , Bile Ducts/diagnostic imaging , Cholangiography , Jaundice/etiology , Abdominal Injuries/surgeryABSTRACT
This study describes the first case of biliary peritonitis after radiofrequency ablation diagnosed by magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), a hepatocyte-specific MR imaging contrast agent. The image acquired 300 minutes after the administration of Gd-EOB-DTPA was useful to make a definite diagnosis and to identify the pathway of bile leakage. It is important to decide on the acquisition timing with consideration of the predicted location of bile duct injury.
Subject(s)
Aged, 80 and over , Humans , Male , Bile Duct Diseases/diagnosis , Carcinoma, Hepatocellular/diagnosis , Catheter Ablation/adverse effects , Contrast Media , Diagnosis, Differential , Follow-Up Studies , Gadolinium DTPA , Hepatectomy/adverse effects , Liver Neoplasms/diagnosis , Magnetic Resonance Imaging/methods , Peritonitis/diagnosisABSTRACT
One of the rare complications of choledochal cysts is rupture. In majority of the cases, the cause of rupture is unknown. Reconstructive surgery is the treatment of choice. We describe three patients with choledochal cyst rupture, who were admitted with acute abdomen. Diagnosis of biliary ascites with peritonitis was made in all the three patients. At surgery, two patients underwent T-tube placement, and definitive repair was done electively. One patient underwent definitive repair of ruptured choledochal cyst, but died due to septicemia. External bile drainage would be safer in emergency condition.
ABSTRACT
The authors report a case of spontaneous perforation of the biliary tract (S.P.B.T) in a three-month-old infant. The diagnosis was suspected before the operation by clinical signs and diagnostic tests. The importance of paracentesis and scintigraphy is stressed. A surgical approach was chosen and drainage procedure of the area around the perforation and a cholecystostomy were done. S.P.B.T. is rare and its etiology is controversial, but cannot be forgotten in association between biliary ascites and cholestatic jaundice during the first months of life.