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Tue, 08 Jan 2002 07:51:21 -0500

I believe an ERCP would help locate the fistula better and give you your 
options. If a leak is from the liver of bile ducts you might try passing 
a stent  to open the ampulla which may relieve enough pressure to close 
the fistula. If an injury to the GB it should just be taken out.
Ronald Simon, MD
Director of Trauma/SICU
Jacobi Medical Center
Bronx, NY

Honorio Ma. Jr. Pangilinan wrote:

>I have a 22 year old male patient who was referred to
>our facility after sustaining 2 GSWs to the back. He
>was initially admitted to a remote provincial hospital
>where he reportedly underwent laparotomy for repair of
>multiple intestinal perforations. He was subsequently
>transferred to our facility 33 hours post-injury.
>
>On admission he was stable, normotensive, afebrile. He
>had 2 GSWs at the back, one at level L1 left mid
>scapular line, and another at level T10 right
>posterior axillary line. Anteriorly he had a sutured
>midline laparotomy incision and there was a GSW of
>exit in the epigastrium, just to the right of the
>midline from which was oozing brownish fluid (bile).
>The abdomen was flat, soft, with slight tenderness on
>palpation around the incision, otherwise, everything
>was unremarkable. 2 days later, he was still afebrile,
>the abdomen was soft and non-tender, and he was
>hungry. The output from the GSW of exit was 700 cc.
>Suspecting a biliary-cutaneous fistula a soft Fr 10
>rubber catheter was inserted into the cutaneous
>opening and a fistulogram was done. This revealed
>opacification of the gall bladder and intra hepatic
>ducts. There was no spillage of contrast into the
>peritoneal cavity. Patient is now on his 5th day in
>our hospital, he is feeding, has passed flatus and
>stools, and remained afebrile. No abdominal
>complaints, no jaundice. Fistula output is 750 to 900
>cc bile per day. We plan to operate on him to try to
>locate the source of the bile leak.
>
>Is there room for non-operative management in this
>case? Any opinion from the list will be appreciated.
>
>Dr. Jun Pangilinan
>Baguio General Hospital
>Baguio City, Philippines 
>
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bile fistula