NONOPERATIVE MANAGEMENT OF BILIARY-TRACT FISTULAS AFTER BLUNT ABDOMINAL-TRAUMA IN A CHILD

Nonoperative treatment was carried out in a 12-year-old girl who prese nted with biliary fistulas after blunt abdominal trauma with hepatic i njury. A computed tomography-guided percutaneous puncture showed bilia ry peritonitis and permitted the positioning of an efficient intraperi toneal drainage. Endoscopic retrograde cholangiography was very helpfu l for visualization and accurate localization of biliary injuries. Thi s permitted positioning a nasobiliary drain to reduce intrabiliary pre ssure and to bypass a lesion of the common hepatic duct. This nonopera tive management allowed healing of fistulas within 20 days, without bi le duct stricture (noted on the follow-up intravenous cholangiogram 18 months later). (C) 1995 by W.B. Saunders Company