Presentation
Herein, we present a case outlining the algorithmic treatment approach for delayed-presentation complex biliary injury and report on the novel use of small intestinal submucosal biomaterial for surgical site control in the staged repair of a complex biliary [ncbi.nlm.nih.gov]
Liver, Gall & Pancreas
- Jaundice
Pain, jaundice and bile collections were the typical presenting features of injuries that became evident after laparoscopic cholecystectomy. ERCP and PTC accurately defined the injuries. [ncbi.nlm.nih.gov]
Workup
E4 and E5 Strasberg injuries. 5 In conclusion, to achieve the best results in BDI management, patients should be treated by a multidisciplinary team, including surgeons, endoscopists, and radiologists, to allow the better, most efficient diagnostic workup [medcraveonline.com]
Laboratory workup was significant for total bilirubin 15.1 mg/dl, creatinine 1.1 mg/dl, AST 150 U/l (normal < 40 U/l), ALT 434 U/l (normal 58 U/l), Alkaline phosphatase 175 U/l (normal < 117 U/l), White blood cells 15.3 × 10^ 3 /cm 2, hematocrit 26%, [academic.oup.com]
Data collected included clinical presentation, time interval between surgery and ERCP, preoperative workup (clinical evaluation, biochemical and hematological testing, US, MRCP) and ERCP imaging results were reviewed to categorize lesions and determine [saudijgastro.com]
After diagnostic workup, the type of BDIs was classified according to the Strasberg classification [Table 2], with almost 2/3 of patients presented with variable degrees of bile duct injury and leakage (Grades from A-D), whereas 1/3 of patients presented [saudisurgj.org]
Treatment
Their initial treatment modalities were non-surgical. The success rate of non-surgical treatment in each group was as follows: BDI type 1: 94%; type 2: 71%; and type 3: 30%. [ncbi.nlm.nih.gov]
Prognosis
Because of their small size, leaks originating from these ducts have good prognosis and almost never require surgical intervention. [ncbi.nlm.nih.gov]
The long-term prognosis will depend on early diagnosis and efficient therapeutic management. [link.springer.com]
Etiology
Biliary atresia (BA) is an infantile obstructive cholangiopathy of unknown etiology with suboptimal therapy, which is responsible for 40 to 50% of all pediatric liver transplants. [ncbi.nlm.nih.gov]
Iatrogenic bile duct injuries: etiology, diagnosis and management. WJG. 2009;15(33):4097-104. Kaman L, Behera A, Singh R, Katariya R. Management of major bile duct injuries after laparoscopic cholecystectomy. Surg Endosc. 2004;18(8):1196-9. [msjonline.org]
Iatrogenic bile duct injuries: Etiology, diagnosis and management. World J Gastroenterol 2009;15:4097-104. 2. Chiruvella A, Sarmiento JM, Sweeney JF, Lin E, Davis SS Jr. [saudisurgj.org]
Epidemiology
We aimed to determine the epidemiology of mesh explantation after ventral hernia repair and to compare this with common bile duct injury, a dreaded complication of laparoscopic cholecystectomy. [ncbi.nlm.nih.gov]
Epidemiology Frequency Although the exact incidence of nonoperative biliary trauma is unknown, isolated biliary injury without trauma to associated intra-abdominal structures is extremely rare (less than 1% of all blunt abdominal injuries in most series [emedicine.medscape.com]
Thus, when epidemiologic studies were done using this narrow definition, birth asphyxia was found to be a minuscule cause of Cerebral Palsy. [mondaq.com]
Pathophysiology
Pathophysiology Typically, a mechanism of crushing or shear injury to the right upper quadrant causes biliary disruption and subsequent bile-peritonitis. [emedicine.medscape.com]
ACOG "produced" a 2003 study entitled "Neonatal Encephalopathy in Cerebral Palsy: Defining the Pathogenesis and Pathophysiology." [mondaq.com]
Prevention
To prevent BDI, techniques have been developed for intraoperative assessment of bile duct anatomy. [ncbi.nlm.nih.gov]