Nonoperative therapy of the posttraumatic biliary fistula in adolescents.

Posttraumatic biliary fistula is one of the complications of major hepatic injury. Conventional treatment has consisted of surgical intervention with hepatic debridement, ductal repair, and controlled drainage. The authors present two boys, 15 and 17 years of age, with biliary fistulas resulting after major hepatic injury. Biliary fistulas were successfully treated nonoperatively with sphincterotomy and endoscopically inserted small-caliber stents. The duration of time between stent placement and closure of the fistulas were 2 and 8 days, respectively.2.5 years after injury, both patients are without problems. These cases demonstrate the effectiveness of nonoperative management of traumatic biliary fistulas in adolescents.

Endoscopic retrograde cholangiopancreatography in infants and children.

BACKGROUND: Although many reports describe the use of diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in children, few mention therapeutic application of this technique in pediatric patients with pancreatic or biliary disease. METHODS: We report our 4-year experience of 80 ERCPs performed in 59 children for obstructive jaundice or cholestasis with dilatation of the biliary tree (32 children), biliary atresia (11), recurrent pancreatitis (8), and blunt trauma to the abdomen (8). RESULTS: The patients' ages ranged from 5 weeks to 18 years. The appropriate duct was cannulated in 94% of cases. Common bile duct sphincterotomy was performed in 35 patients and pancreatic duct sphincterotomy in one. Multiple procedures were done in 16 patients where biliary stents were inserted; in one patient with chronic pancreatitis and pancreaticolithiasis, pancreatic stent was inserted. Four patients developed mild pancreatitis, one had moderate pancreatitis and one had leak of contrast, which was treated by administration of clear fluids orally for one day. One patient with benign stenosis of the hepatic duct developed cholangitis after migration of the stent into the bowel lumen. CONCLUSION: Diagnostic and therapeutic ERCP can be done as safely and effectively in pediatric patients as in adults.

[Rupture of the pancreas in children--present trends in diagnosis and therapy]. / Ruptura pankreatu v detském veku--soucasné trendy v diagnostice a terapii.

Evaluation of pancreatic injuries is presented in the professional literature in retrospective studies and views on treatment vary. The authors evaluated also in a retrospective study a group of eight child patients with a serious injury of the pancreas. The patients were 3-13 years old and were hospitalized at the Clinic of Paediatric Surgery at the Faculty Hospital Motol in 1985-1999. The group is formed by patients with pancreatic injuries (according to the Japanese classification type II and III). The authors evaluate not only diagnostic but also therapeutic procedures. In the diagnosis they evaluate the ultrasonographic examination (USG) as the examination of first choice which however need not record the extent and severity of the pancreatic injury. Computing tomography (CT) and magnetic resonance (MRI) can make the original suspicion of injury more accurate, ERCP is an examination which reveals in particular type III injuries--i.e. those with affection of the pancreatic duct. Injured children where a serious pancreatic lesion was not diagnosed primarily, had to be subjected to repeated surgical revisions. All children in the presented group recovered, none of the patients died.

[Contusion of the lungs in childhood]. / Kontuze plic v detském veku.

The authors evaluated in a retrospective study a group of 45 patients with contusion of the lungs (age 1 to 15 years) who were treated at the Faculty Hospital in Motol in 1989-1993. In 38 children contusion of the lungs was part of multiple injuries with signs of failure of vital functions. These children were admitted after the injury to the in-patient department of the Anaesthesiological and Resuscitation Clinic. Seven children without alterations of vital functions were treated at the Department of Paediatric Surgery. The diagnosis was based on the case-history, clinical examination, X-ray examination and laboratory signs of lung injuries. An isolated pneumothorax was found in 17.8% of the injured children, haemothorax in 8.9% and in 24.5% pneumothorax and haemothorax. Severe craniocerebral injuries were diagnosed in 71% of patients, 37.8% children had concomitant injuries of the abdominal organs and retroperitoneum and 42% had fractures of the long bones. 46.6% of the children had rib fractures. The condition of 35 injured children called for endotracheal intubation (on average for 17 days) and artificial ventilation (on average for 14.4 days). 98% of the injured children were given antibiotics, in 84% steroids were administered, in 18 of the injured children (40%) drainage of the thoracic cavity was essential. Six patients (13.3%) drainage of the thoracic cavity was essential. Six patients (13.3%) died--the cause of death were severe injuries of the CNS.