INTRAHEPATIC BILIARY LESIONS FOLLOWING BLUNT LIVER TRAUMA IN CHILDREN- IS NONOPERATIVE MANAGEMENT OR CONSERVATIVE OPERATIVE TREATMENT ALWAYS SAFE

Nonoperative management of blunt liver injuries has become standard ca re for children, in the absence of hemodynamic instability. However, a ttention has to be drawn to biliary complications which can manifest t hemselves after a latent period, even in the presence of rupture of ma in biliary ducts. Peripheral bile duct lesions are easily treated by w ide drainage. However, the extremely rare intrahepatic main bile duct lesions require other treatments. We report 2 cases of severe liver tr auma associated with intrahepatic bile duct lesions: the first, manage d nonoperatively, developed biliary peritonitis on day 21. Lesions of the main right biliary ducts were discovered. Because the right liver vascularization was not compromised, an intrahepatic biliary reconstru ction was performed through a large hepatotomy according to the functi onal anatomy. The second child, who had an emergency laparotomy on adm ission, suffered nevertheless from a bilioma, drained on day 38. Becau se of increasing daily bile flow through the drain a second laparotomy was performed that demonstrated a biliary leak from a main segmental duct. Resection of the segment cured the patient. These two cases illu strate the occurrence of intrahepatic main bile duct lesions, clinical ly apparent after a latent period, following blunt trauma of the liver treated by nonsurgical or conservative surgical management. Intrahepa tic biliary reconstruction is an alternative to liver resection when v iable vascularization of the involved sector justifies its preservatio n.