Endoscopic Retrograde Cholangiopancreatography Is an Effective Treatment for Bile Leak After Severe Liver Trauma

2011 ◽  
Vol 71 (2) ◽  
pp. 480-485 ◽  
Author(s):  
Rahul J. Anand ◽  
Paula A. Ferrada ◽  
Peter E. Darwin ◽  
Grant V. Bochicchio ◽  
Thomas M. Scalea
Keyword(s):  
Effective Treatment ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bile Leak ◽  
Liver Trauma ◽  
Severe Liver ◽  
Endoscopic Retrograde

scholarly journals An Unusual Recurrent Bile Leak Following High Grade Liver Trauma

2021 ◽  
Vol 11 (3) ◽  
pp. 137-140
Author(s):  
Morgan E Jones ◽  
Ee Jun Ban ◽  
Charles H. C. Pilgrim
Keyword(s):  
Liver Injury ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
High Speed ◽  
Bile Leak ◽  
Biliary Tree ◽  
Operative Management ◽  
Liver Trauma ◽  
Post Injury ◽  
Endoscopic Retrograde ◽  
Non Operative Management

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.

scholarly journals Management of Traumatic Liver and Bile Duct Laceration

2017 ◽  
Vol 7 (2) ◽  
pp. 188-190 ◽  
Author(s):  
Pankaj Dwivedi ◽  
Mukta Waghmare ◽  
Hemanshi Shah ◽  
Charu Tiwari ◽  
Kiran Khedkar
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Blunt Abdominal Trauma ◽  
Percutaneous Drainage ◽  
Hepatic Duct ◽  
Bile Leak ◽  
Liver Trauma ◽  
High Grade ◽  
Hepatic Trauma ◽  
Endoscopic Retrograde

ABSTRACT Posttraumatic major bile leak in children is uncommon, with few cases reported in the literature. These injuries are seen in high-grade liver trauma and are difficult to diagnose and manage. We describe a 7-year-old boy with grade IV hepatic trauma and bile leak following blunt abdominal trauma. The leak was successfully managed by percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP) stenting of the injured hepatic duct. How to cite this article Tiwari C, Shah H, Waghmare M, Khedkar K, Dwivedi P. Management of Traumatic Liver and Bile Duct Laceration. Euroasian J Hepato-Gastroenterol 2017;7(2):188-190.

scholarly journals Experience with laparoscopic common bile duct exploration in failed endoscopic retrograde cholangiopancreatography cases at a tertiary care hospital

2020 ◽  
Vol 7 (10) ◽  
pp. 3344
Author(s):  
Pradeep Panwar ◽  
Hetish M. Reddy ◽  
Rajendra Bagree ◽  
Gaurav Jalendra
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
Bile Leak ◽  
Common Bile Duct Exploration ◽  
Care Hospital ◽  
Early Recovery ◽  
Endoscopic Retrograde ◽  
Tube Removal

Background: Minimally invasive techniques for stone removal in common bile duct (CBD) are endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) or laparoscopic CBD exploration with LC (laparoscopic common bile duct exploration (LCBDE) and LC). Failed, multiple attempted or complications of ERCP leads to other surgical approaches where LCBDE is a preferable option by experts due to its added benefits.Methods:  We did LCBDE and LC in 40 cases of failed ERCP. Standard investigation protocol was followed in all cases and CBD were explored laparoscopically and stones were retrieved. Post retrieval choledochoscopy was done and sphincter of oddi was dilated by the dilators.Results: With careful selection of cases, stone calculi were retrieved successfully in 38 cases by laparoscopically and 2 cases by open method after conversion. Postoperative choledochoscopy were found normal. Bile leak seen in 3 cases, which were managed conservatively. Standard regime of postoperative care was taken followed by T-tube removal after cholangiogram on day 10-14. All patients survived the operation.Conclusion: We advocate that LCBDE is the most viable alternative for open surgery in failed ERCP cases for retrieval of CBD stones. This results in early recovery, better cosmetic scar, least complications with early resumption of routine life. Needs cautious patient selection and expertise in laparoscopic surgery.

scholarly journals Endoscopic retrograde cholangiopancreatography (ERCP) in critically ill patients is safe and effective when performed in the endoscopy suite

2020 ◽  
Vol 08 (09) ◽  
pp. E1165-E1172
Author(s):  
Domenico A. Farina ◽  
Srinadh Komanduri ◽  
A. Aziz Aadam ◽  
Rajesh N. Keswani
Keyword(s):  
Critically Ill ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bile Leak ◽  
Underlying Disease ◽  
Endoscopic Retrograde ◽  
Icu Patients ◽  
Cannulation Success Rate

Abstract Background and study aims Critically ill patients may require endoscopic retrograde cholangiopancreatography (ERCP) but performing ERCP in the intensive care unit (ICU) poses logistic and technical challenges. There are no data on ICU patients undergoing ERCP in the endoscopy suite. The primary aim of this study was to report outcomes, including safety, when ERCP in critically ill patients is performed in the endoscopy suite. Patients and methods We queried our institutional endoscopy database to identify all ICU patients who underwent ERCP at a single academic medical center from 04/01/2010 to 11/30/2017. Only patients admitted to an ICU prior to ERCP were included. Results Of 7,218 ERCPs performed during the study period, 260 ERCPs (3.6 %) were performed in 231 ICU patients (mean age 61y; 53 % male); nearly all ICU patient ERCPs (n = 258; 99 %) occurred in the endoscopy suite. ERCP indications included cholangitis (50 %), post-liver transplant cholestasis (15 %), and bile leak (10 %). All ERCPs were performed with anesthesiology, most with general anesthesia (60 %) and in the prone position (60 %). Most patients (73 %) had sepsis. Prior to ERCP, 17 % of patients required vasopressors; vasopressors were begun during ERCP in 4 %.The cannulation success rate was 95 % (94 % in native papillae). Adverse events occurred in 9 % (n = 23) of cases with post-ERCP pancreatitis most common. No patients died during or within 24 hours of ERCP. Mortality at 30 days was 16 %, all attributed to underlying disease. Conclusions When advanced ventilatory and hemodynamic support is available, critically ill patients can safely and effectively undergo ERCP in the endoscopy suite.

scholarly journals Bile Duct Injury in Children: Is There a Role for Early Endoscopic Retrograde Cholangiopancreatography?

2018 ◽  
Vol 04 (03) ◽  
pp. e119-e122 ◽  
Author(s):  
Akram Aljahdali ◽  
James Murphy
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Pediatric Patients ◽  
Bile Leak ◽  
Standard Of Care ◽  
Bile Peritonitis ◽  
Endoscopic Retrograde ◽  
Liver Injuries ◽  
Bile Duct Stent ◽  
Bile Leaks

Introduction Liver injury is common among pediatric abdominal trauma. Nonoperative management is the standard of care in isolated stable liver injuries. Bile leak is not an uncommon complication in moderate- and high-grade injuries. Case series Three pediatric patients (age: 10–15 years) suffered grade IV liver injuries secondary to blunt abdominal trauma. All developed significant bile leak treated nonoperatively with endoscopic retrograde cholangiopancreatography (ERCP), and patients 1 and 2 were treated with bile duct stent alone. Patient 3 required laparotomy for bile peritonitis and abdominal compartment syndrome followed by interval ERCP and bile duct stent. Conclusion Traumatic bile leaks if not recognized and managed early can result in significant morbidity. This paper describes the presentation and treatment of three pediatric patients with blunt liver trauma complicated by significant bile leaks that were managed successfully with ERCP and bile duct stent. This paper demonstrates the importance of early detection of bile leak to prevent bile peritonitis. Abdominal imaging 4 to 5 days postinjury can help in detecting bile accumulation. We believe that ERCP and bile duct stent are becoming the standard of care in diagnosing and treating traumatic bile leak. This paper confirms the safety and feasibility of this technique in the pediatric population.

scholarly journals Fractured T Tube Fragment in Common Bile Duct during Retrieval: An Unforeseen Mishap

2021 ◽  
Vol 07 (03) ◽  
pp. e251-e254
Author(s):  
Deepak Rajput ◽  
Itish Patnaik ◽  
Sruthi Shasheendran ◽  
Beeram K. Prasanna Kumar ◽  
Amit Gupta
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Balloon Catheter ◽  
Bile Leak ◽  
Biliary Fistula ◽  
Intraluminal Pressure ◽  
Endoscopic Retrograde ◽  
T Tube ◽  
Cbd Exploration

AbstractCommon bile duct (CBD) exploration by surgical method—open or laparoscopic, traditionally involved using a T tube to take care of postoperative intraluminal pressure and edema. The complications of T tube include bile leak after removal, formation of biliary fistula, excoriation of the skin, dehydration, saline depletion, retained T tube fragment, CBD obstruction, cholangitis, pancreatitis, and duodenal erosion. Here, we report a case of retained T tube fragment after an attempted removal in an operated case of choledocholithiasis, which was managed by endoscopic retrograde cholangiopancreatography and balloon catheter removal of the remnant.

Endoscopic Retrograde Cholangiopancreatography

2017 ◽  
Author(s):  
Wasif Abidi ◽  
Linda S. Lee
Keyword(s):  
Chronic Pancreatitis ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Acute Cholangitis ◽  
Bile Leak ◽  
Therapeutic Interventions ◽  
Therapeutic Modality ◽  
Pancreatic Ducts ◽  
Type I ◽  
Endoscopic Retrograde ◽  
Duct Stricture

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized endoscopic procedure to view the biliary and pancreatic ducts fluoroscopically. First introduced in the 1970s as a diagnostic tool, ERCP has since evolved primarily into a therapeutic modality and is today regarded as the premier tool for performing therapeutic interventions involving the biliary and pancreatic ductal systems. Relatively complex, ERCP requires advanced training. Although generally considered safe, it does carry a risk of significant complications, including pancreatitis; thus, the most important factor to mitigate complications is to ensure the presence of an appropriate indication for the procedure. This review addresses the indications (e.g., disorders of the major duodenal papilla, biliary diseases, and pancreatic diseases), contraindications, protocol, and complications of ERCP, as well as an overview of the tools available for ERCP procedures. Figures show ampullary adenomas, choledocholithiasis, Mirizzi syndrome, benign common bile duct stricture, primary sclerosing cholangitis, malignant biliary stricture, bile leak, type I and III choledochal cysts, chronic pancreatitis, pancreatic ductal disruption, classic fish-mouth appearance of the papilla in a patient with main duct intraductal papillary mucinous neoplasm, pancreas divisum, side-viewing duodenoscope used for ERCP, and selected tools of ERCP. Tables list the Rome III criteria, risk-stratifying patients for choledocholithiasis, diagnostic criteria for acute cholangitis, choledochal cyst classification, and the Cambridge classification system for chronic pancreatitis. This review contains 15 highly rendered figures, 5 tables, and 77 references.

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