Role of Percutaneous Transhepatic Biliary Endoprostheses with Distal Tube Implantation in the Subcutaneous Space for Management of Patients with Postoperative Biliary Stricture

The role of endoscopic retrograde cholangiopancreatography (ERCP) in the trauma patient is limited. Therefore, reporting of outcomes is sparse in the literature. The purpose of this study was to review outcomes of patients who underwent ERCP for traumatic biliopancreatic injury. We retrospectively reviewed 1550 ERCPs, from a prospectively maintained database, performed by a single surgical endoscopist consulted by the trauma surgical service for the management of traumatic fistulae. Referral was made for patients with high output (greater than 200 mL/d) and/or persistent (failure to resolve within 30 days) fistulae and traumatic biliary stricture. Primary end point was postprocedural complications. Secondary end points included patient characteristics, stents placed, and duration of stenting. Seventeen patients underwent a total of 31 ERCPs for biliary and/or pancreatic injury resulting from abdominal trauma (eight penetrating, nine blunt). Fourteen patients had ERCP after laparotomy, with a mean interval to ERCP of 74 days. In three patients, ERCP was the only intervention required. Fourteen biliary stents were placed, seven of which were metallic. Ten pancreatic stents were placed; one proximally migrated but was successfully retrieved. Four patients had both ducts simultaneously stented. The mean duration of stenting was 158 days. All fistulae resolved after stenting. There were no serious complications.

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Combined Interventional Radiological and Endoscopical Approach for the Treatment of a Postoperative Biliary Stricture and Fistula

HPB Surgery ◽

10.1155/1995/48252 ◽

1995 ◽

Vol 8 (4) ◽

pp. 257-262

Author(s):

Jürgen Triller ◽

Adrian Schmassmann ◽

Walter Schweizer ◽

Abraham Czerniak

Keyword(s):

Biliary Stricture ◽

Open Cholecystectomy ◽

Bile Leakage ◽

Biliary Fistula ◽

Emergency Laparotomy ◽

Percutaneous Balloon ◽

External Drain ◽

Percutaneous Balloon Dilatation ◽

Iatrogenic Bile Duct Injury

A 43-year old woman was admitted 11 days after open cholecystectomy with a iatrogenic bile duct injury. On admission the patient showed an uncontrolled biliary fistula through an external drain placed at an emergency laparotomy for biliary peritonitis with fever and jaundice. PTC showed a biliary stricture type II (Bismuth). A percutaneous drainage was performed to decompress the biliary system. Three weeks later, percutaneous balloon dilatation of the stricture was performed. However, bile leakage persisted. In a combined transhepatic/ endoscopic procedure, the percutaneous biliary drainage was replaced by a nasobiliary tube. One week later, no stricture was found and the biliary leak was sealed. The patient could be discharged without symptoms or signs of cholestasis. The multidisciplinary management of post-operative biliary fistula is presented, comparing the role of interventional radiology, endoscopy and surgery.

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Can Extravasation Injury Cause Subcutaneous Compartment Syndrome of the Hand?

Plastic Surgery Case Studies ◽

10.1177/2513826x17728258 ◽

2017 ◽

Vol 3 ◽

pp. 2513826X1772825

Author(s):

Victor W. Wong ◽

Philip J. Hanwright ◽

Michele A. Manahan

Keyword(s):

Compartment Syndrome ◽

Tissue Perfusion ◽

Acute Compartment Syndrome ◽

Tissue Loss ◽

Rapid Improvement ◽

Subcutaneous Space ◽

Cutaneous Perfusion ◽

Compartment Pressures

Background: Compartment syndrome of the hand is a well-described phenomenon with potentially devastating consequences. Although numerous mechanisms have been proposed, the extravasation of peripheral intravenous (IV) fluids remains a relatively rare etiology. Objective: Surgical dogma mandates emergent decompressive fasciotomies in the presence of hand dysfunction and impending tissue loss from supraphysiologic compartment pressures. The role of the subcutaneous space in acute compartment syndrome remains unclear. Methods: In this report, we present a case of a dorsal hand IV extravasation leading to an acute compartment syndrome of the subcutaneous space. Results: An emergent skin-only incision was used for decompression, with immediate improvement in symptoms and no long-term adverse sequelae. Discussion: The subcutaneous space appears capable of sustaining supraphysiologic pressures that impair cutaneous perfusion. This closed anatomic space can be readily decompressed, resulting in rapid improvement in soft tissue perfusion. However, its role in contributing to acute compartment syndrome of the hand requires further research. Conclusion: We propose consideration of the subcutaneous space as a distinct hand compartment and advocate selective compartment release when prudent.

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