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]

• Respiratory Distress

  Upon arrival, the patient was in severe respiratory distress consistent with sickle cell crisis, sinus tachycardia with heart rate 156, blood pressure 173/87, pulse oximetry 92% with high flow nasal cannula at 30 l/min. [academic.oup.com]

• 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]

• Myalgia

  Reported frequent adverse events of the medication include nausea, depression, myalgia, abdominal pain and abnormal liver function tests. [ncbi.nlm.nih.gov]

• Suggestibility

  Preoperative ultrasound and endoscopic retrograde cholangiography suggested choledocholithiasis, showing proximal and intrahepatic duct dilatation with an inability to relieve the obstruction. [ncbi.nlm.nih.gov]

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%, hemoglobin [academic.oup.com]

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]

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]

• Antinuclear Autoantibodies

  The titer of antismooth muscle antibody (SMA) was 1:80, while antinuclear autoantibody (ANA) and the M2 fraction of antimitochondrial antibody (AMA) were both negative. [ncbi.nlm.nih.gov]

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]

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]

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]

OBJECTIVE: To describe the epidemiological, clinical and surgical features of patients with iatrogenic bile duct injury (IBDI) attending the General Hospital of Fortaleza (HGF) during the period from 2005 to 2009. [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 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]

To prevent BDI, techniques have been developed for intraoperative assessment of bile duct anatomy. [ncbi.nlm.nih.gov]