Successful endoscopic treatment of biliary leaks after severe gunshot liver trauma in combat abdominal injury

Yaroslav Zarutskyi, Viktor Slobodianyk, Sergey Armenakovich Aslanyan, Oleksandr Savytskyi, Andrii Tkachenko, Pavlo Forostyanyi, Viktor Honcharuk, Mykhailo Vovk

Abstract


Objective: The improvement of treatment of liver gunshot injuries, which are complicated by the formation of bile leaks, by applying endoscopic retrograde cholangio-pancreatography and stenting of the bile ducts.

Patients and methods: The analysis of the treatment of 18 wounded patients with severe gunshot injuries of the liver and the formation of bile leaks was conducted. They underwent endoscopic retrograde cholangio-pancreatography and bile duct stenting.

Results: After endoscopic retrograde cholangio-pancreatography, there was a marked decrease in the amount of bile that drained outwards (by an average of 50.8% for the first day) with a cessation of bile leak after 4 - 6 days. In 3 patients there were limited bilomas formed, which were evacuated via percutaneous puncture under ultrasound guidance. Temporary stent from the common bile duct was removed after 30-45 days in an outpatient setting.

Conclusion: In the surgical treatment of severe injuries of the liver, the frequency of complications associated with bile leaks (bile peritonitis, bilomas, external bile fistula) reaches 86 - 93%. Endoscopic retrograde cholangio-pancreatography allows to determine the source of bile leaks, and endobiliary stenting is the method (surgery) of choice in the treatment of bile fistula. Minimally invasive methods of puncture drainage hemobilomas help to avoid their suppuration, and if the latter - to drain the purulent focus without laparotomy.



Keywords


gunshot liver injury, bile leaks, endoscopic retrograde cholangio-pancreatography, bile duct stenting.

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References


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