Castro-Ortega U, Ruiz-Ruiz R, López-Colombo A, Montiel-Jarquín A, Loría-Castellanos J

Language: Spanish
References: 7
Page: 24-27
PDF size: 304.73 Kb.

ABSTRACT

Background: Post traumatic biliary fistula is the abnormal passage of liquid from the biliary tract to another organ, cavity or when an artificial drainage to the external surface of the abdomen exists. It is a relatively rare post traumatic sequel, that occurs between 0.5 and 2.6% of the hepatic traumatic cases. Previously, the treatment required a long hospital stay, nowadays the endoscopic management decreased considerably the hospital stay, as well as the morbidity and mortality in these patients. The objective is to describe a case with postraumatic biliary fistula managed with a Cotton 10 FR prosthesis placed endoscopically.
Clinical case: 28-year-old male, suffering from abdominal contusion against the steering wheel causing liver lacerations and biliary fistula, which was treated conservatively for a week. . He underwent an exploratory laparotomy for acute abdomen with 3000 mL of bile fluid, afterwars a drain was placed. A biliary leak continued through the drain (greater than 500mL/24 h), an endoscopic retrograde cholangiopancreatography was performed and a biliary type II fistula was found. A Cotton 10 FR prosthesis was placed and 24 hours later the spending decreased to less than 50mL in 24 h. The drainage was removed on the eighth day and three months later the prosthesis was also removed, no mediate or late complications were presented.
Conclusion: The conservative treatment does not offer good results; therefore the endoscopic stent placement is a safe and effective therapeutic alternative.

REFERENCES

1. Duzgun AP, Ozmen MM, Ozer MV, Coskun F. Internal biliary fistula due to Cholelithiasis: A single-centre experience. World J Gastroenterol. 2007;13(34):4606-9.

2. Grala P, Skrzwanek P, Sowier A. Biliary fistulas resulting from blunt hepatic injury treated by endoscopic diversion of the bile flow. Acta Chir Belg. 2009;109(1):47-51.

3. Barclay GR, Crampton JR. ERCP in late post-traumatic biliary fistula. Postgrad Med J. 1987;63:147-9.

4. El-Shehry AH. Biliary fistulas. EJS. 2004;23(1):98-113.

5. Landaeta J, Mutti L, Rodríguez M, Rojas B, Vásquez F, Narváez M, et al. Experiencia en la colocación de prótesis endoscópica en patología biliopancreática. Gen. 2008; 62(3):182-5.

6. Pacahuala-del-Carmen MA, Enríquez-Adalid MR. Tratamiento conservador de la fuga biliar. Después de colecistectomía laparoscópica. Rev Med Inst Mex Seguro Soc. 2011;49(3):301-6.

7. Güitrón A, Adalid R, Barinagarrmentería R, Gutiérrez- Bermúdez JA. Colocación de endoprótesis biliares como tratamiento ambulatorio. Rev Gastroenterol Mex.2001; 66(2):86-9.