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Mascarenhas A, Marques HP, Coutinho J, Martins A, Nolasco F. Liver cirrhosis requiring transplantation in the context of hepaticojejunostomy stricture after a traumatic bile duct injury. Radiol Case Rep 2024; 19:835-838. [PMID: 38188946 PMCID: PMC10770420 DOI: 10.1016/j.radcr.2023.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Biliary injury secondary to trauma is frequently associated with long-term complications. Liver transplantation is rarely indicated but might be the best therapeutic option in severe or intractable cases. We report the case of a 19-year-old male referred for liver transplantation due to biliary injury after abdominal trauma. A Roux-en-Y hepaticojejunostomy was initially performed without immediate complications. Anastomotic stricture developed requiring several trials of biliary dilatation and stenting through a percutaneous approach. The presence of liver cirrhosis and the intractability of this complication culminated in the decision of liver transplantation. The authors present clinical course, complications and interventional procedures that were used in a judicious step-up approach.
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Affiliation(s)
- André Mascarenhas
- Department of Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Hugo Pinto Marques
- Hepato-Biliary-Pancreatic Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Coutinho
- Department of Surgery, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - Américo Martins
- Hepato-Biliary-Pancreatic Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Fernando Nolasco
- Hepato-Biliary-Pancreatic Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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2
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Rajput MZ, Mellnick VM. The Role of Magnetic Resonance in Evaluating Abdominopelvic Trauma - Part 1: Pancreatic and Hepatobiliary Injuries. Can Assoc Radiol J 2022; 73:680-688. [PMID: 35282708 DOI: 10.1177/08465371221077650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Trauma is an important cause of mortality, particularly in the young. While computed tomography (CT) is the mainstay of body imaging in the setting of trauma, magnetic resonance (MR) imaging can be useful in stable patients. Although more commonly used in spinal and musculoskeletal trauma, MR also has a role in abdominopelvic trauma. Broadly, its uses include clarification of equivocal cases, monitoring complications of trauma, particularly with solid organ injury, or as a primary imaging modality for patients with low suspicion for injury for whom avoiding ionizing radiation is a priority-namely, in pediatric and pregnant patients. In this two-part review article, we will review clinical scenarios where this may be encountered, utilizing case examples. This first installment will focus on pancreatic and hepatobiliary injuries. Pancreatic trauma may be difficult to diagnose on CT, and MR may aid in demonstrating pancreatic duct disruption, allowing for accurate grading according to American Association for the Surgery of Trauma (AAST) criteria. It may also be a useful modality for monitoring evolution of pancreatic injuries and/or pseudocyst development, guiding potential stenting, and/or drainage. Biliary injuries are also optimally evaluated with MR, particularly when aided by the use of hepatobiliary contrast material. This can allow for accurate delineation of biliary ductal anatomy and aid in planning percutaneous or endoscopic treatment of bile leaks.
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Affiliation(s)
- Mohamed Z Rajput
- Mallinckrodt Institute of Radiology, 116142Washington University School of Medicine, St Louis, MO, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, 116142Washington University School of Medicine, St Louis, MO, USA
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3
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Gao F, Pan T, Wang Y, Zhu G, Feng Y, Zhu C, Guo J. Biliopleural fistula following percutaneous transhepatic cholangiodrainage and irradiation biliary stent insertion successfully treated with coil embolization: a case description. Quant Imaging Med Surg 2022; 12:1636-1640. [PMID: 35111654 DOI: 10.21037/qims-21-447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/22/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Fulei Gao
- Department of Interventional Radiology, Jiangyin People's Hospital, Jiangyin, China.,Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Tianfan Pan
- Department of Interventional Radiology, Jiangyin People's Hospital, Jiangyin, China
| | - Yong Wang
- Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Guangyu Zhu
- Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yadong Feng
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Cuifang Zhu
- Department of Interventional Radiology, Jiangyin People's Hospital, Jiangyin, China
| | - Jinhe Guo
- Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Southeast University, Nanjing, China
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Reddy S, Lopes Vendrami C, Mittal P, Borhani AA, Moreno CC, Miller FH. MRI evaluation of bile duct injuries and other post-cholecystectomy complications. Abdom Radiol (NY) 2021; 46:3086-3104. [PMID: 33576868 DOI: 10.1007/s00261-020-02947-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022]
Abstract
Laparoscopic cholecystectomy is one of the most common procedures performed each year and can be associated with various post-operative complications. Imaging is integral to diagnosis and management of patients with suspected cholecystectomy complications, and a thorough understanding of normal and abnormal biliary anatomy, risk factors for biliary injury, and the spectrum of adverse events is crucial for interpretation of imaging studies. Magnetic resonance cholangiography (MRC) enhanced with hepatobiliary contrast agent is useful in delineating biliary anatomy and pathology following cholecystectomy. In this article, we provide a protocol for contrast-enhanced MR imaging of the biliary tree. We also review the classification and imaging manifestations of post-cholecystectomy bile duct injuries in addition to other complications such as bilomas, retained/dropped gallstones, and vascular injuries.
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Affiliation(s)
- Shilpa Reddy
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Pardeep Mittal
- Department of Radiology, Medical College of Georgia, Augusta, GA, 30912, USA
| | - Amir A Borhani
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Courtney C Moreno
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
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Howard J, Di Sano S, Burnett D. Spontaneous fistulisation of the common bile duct after transection by gunshot. BMJ Case Rep 2021; 14:14/2/e238473. [PMID: 33541979 PMCID: PMC7868274 DOI: 10.1136/bcr-2020-238473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 35-year-old man presented with a gunshot wound to his abdomen via his lower chest. Initial laparotomy did not identify any perforation or contamination. On day 3, a laparotomy under the hepatobiliary service discovered a gastric perforation, two lateral duodenal perforations and a complete transection of the common bile duct, presumably delayed perforation from the shockwave injury produced by the bullet. Contamination and haemodynamic instability precluded immediate reconstruction, and abdominal drains and external biliary drainage were established. High-volume duodenal fistula was managed with slow withdrawal of drains, and inadvertent dislodgement of the biliary drain in an outpatient setting resulted in spontaneous fistulisation of the bile duct to the lateral duodenal wall, with creation of a neo-bile duct. The patient remains well more than 1 year later, without external drainage despite no surgical reconstruction.
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Affiliation(s)
- Jessica Howard
- Hepatobiliary Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Suzanne Di Sano
- Hepatobiliary Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - David Burnett
- Hepatobiliary Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia
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Endoscopic Diagnosis and Management of Gastrointestinal Trauma. Clin Gastroenterol Hepatol 2021; 19:14-23. [PMID: 31605872 DOI: 10.1016/j.cgh.2019.09.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/28/2019] [Indexed: 02/07/2023]
Abstract
Trauma affects all sociodemographic profiles and is a major cause of morbidity and mortality particularly in patients less than forty years of age. A variety of endoscopic tools and techniques initially used for iatrogenic etiologies (post-operative bile or pancreatic duct leaks, intra-procedural perforation) have been adopted for use in the gastrointestinal trauma victim. The purpose of this review is to highlight a variety of gastrointestinal traumatic complications where endoscopy can serve a complement and/or definitive management strategy.
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Imaging of Postoperative Biliary Complications. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00368-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vasiliadis K, Moschou E, Papaioannou S, Tzitzis P, Totsi A, Dimou S, Lazaridou E, Kapetanos D, Papavasiliou C. Isolated aberrant right cysticohepatic duct injury during laparoscopic cholecystectomy: Evaluation and treatment challenges of a severe postoperative complication associated with an extremely rare anatomical variant. Ann Hepatobiliary Pancreat Surg 2020; 24:221-227. [PMID: 32457271 PMCID: PMC7271109 DOI: 10.14701/ahbps.2020.24.2.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
Abstract
A typical bile duct branching patterns represent one of the major causes of bile duct injury (BDI) during laparoscopic cholecystectomy (LC). The most common classified variations of bile duct branching, involve the right posterior sectoral duct (RPSD) and its joining with the right anterior or left hepatic duct. Variant bile duct anatomy can rarely be extremely complex and unclassified. This report describes an extremely rare case of an isolated injury to an aberrant right hepatic duct formed by the joining of ducts from segments V, VII, and VIII draining into the cystic duct (cysticohepatic duct) during LC, associated with an inferior RPSD opening to left hepatic duct. Detailed evaluation of both endoscopic and magnetic cholangiograms established the diagnosis. Bile duct injury was subsequently managed surgically by a demanding Roux-en-Y hepaticojejunostomy. This extremely rare case aims to serve as a useful reminder of the consistent inconsistency of biliary anatomy, alerting surgeons to beware of variant bile duct branching patterns during open or LC that constitute a dreadful pitfall for severe and life-threatening bile duct injuries.
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Affiliation(s)
| | | | - Sofia Papaioannou
- Department of Radiology, General Hospital Papageorgiou, Thessaloniki, Greece
| | | | | | | | - Eleni Lazaridou
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Kapetanos
- Department of Gastroenterology, General Hospital Papanikolaou, Thessaloniki, Greece
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Schizas D, Papaconstantinou D, Moris D, Koliakos N, Tsilimigras DI, Bakopoulos A, Karaolanis G, Spartalis E, Dimitroulis D, Felekouras E. Management of Segmental Bile Duct Injuries After Cholecystectomy: a Systematic Review. J Gastrointest Surg 2019; 23:408-416. [PMID: 30402723 DOI: 10.1007/s11605-018-4027-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Injuries to segmental or aberrant bile ducts are encountered less commonly than their major bile duct counterparts and present a unique diagnostic and therapeutic challenge, since the nature of this injury involves a transected bile duct that loses its communication with the main ductal system. In this systematic review, we aim to pool available data on this particular type of biliary injury in an effort to outline available diagnostic and therapeutic modalities and evaluate their efficacy. MATERIALS AND METHODS An extensive literature search was performed on MEDLINE, Scopus, and Web of Science to identify isolated segmental or aberrant bile duct injuries. RESULTS A total of 21 studies were included in this systematic report. Ten studies reported non-operative management of patients, while 12 reported operative management of included patients. Outcomes of interest were the choice of treatment interventions and their success. Overall, 23 patients were managed non-operatively with a 91% success rate and 30 patients were managed operatively with a 90% success rate. CONCLUSION Non-operative management might be a viable alternative to surgery. Hepatobiliary surgeons should be encouraged to publish their results in treating these rare injuries to further elucidate the role and efficacy of such an approach.
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Affiliation(s)
- Dimitrios Schizas
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Papaconstantinou
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Koliakos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anargyros Bakopoulos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Karaolanis
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- 2nd Propedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- 2nd Propedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Felekouras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Şimşek A, Kılcı MB, Karabulut E, Sansal M, Ünal B. Vacuum-assisted closure in the treatment of biliary leakage following gunshot injury to the liver. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 30:658-659. [PMID: 30541719 DOI: 10.5152/tjg.2018.18373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Arife Şimşek
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Mahmut Burak Kılcı
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Ertuğrul Karabulut
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Müfit Sansal
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Bülent Ünal
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
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11
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Gastroduodenal and pancreatic surgeries: indications, surgical techniques, and imaging features. Abdom Radiol (NY) 2017; 42:2054-2068. [PMID: 28493073 DOI: 10.1007/s00261-017-1165-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This review article focuses on gastroduodenal and pancreatic surgeries with the goal of identifying radiologic findings that translate to important surgical considerations. The topics covered include partial gastrectomy with reconstruction techniques, total gastrectomy, pancreaticoduodenectomy, and pancreaticojejunostomy. Indications, contraindications, surgical techniques, and postoperative imaging are described within each of these topics. Knowledge of these surgical techniques is extremely helpful for the interpreting radiologists to identify expected postoperative anatomy and related complications that would remain clinically relevant to our surgical colleagues and direct timely patient management.
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12
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Graves JA, Hanna TN, Herr KD. Pearls and pitfalls of hepatobiliary and splenic trauma: what every trauma radiologist needs to know. Emerg Radiol 2017; 24:557-568. [DOI: 10.1007/s10140-017-1515-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/05/2017] [Indexed: 12/26/2022]
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Park CI, Park SJ, Lee SB, Yeo KH, Choi SU, Kim SH, Kim JH, Baek DH. Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report. JOURNAL OF TRAUMA AND INJURY 2016. [DOI: 10.20408/jti.2016.29.3.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chan Ik Park
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Sung Jin Park
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Sang Bong Lee
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Kwang Hee Yeo
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Seon Uoo Choi
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Seon Hee Kim
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Jae Hun Kim
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
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