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Tue, 8 Jan 2002 10:35:26 -0000

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Perhaps you must try to perform an ERCP wich would be not only =
diagnostic where the biliary duct injury is, but con allow complete =
biliary diversion to duodenum by plastic endostenting or sphincterotomy =
with nasobiliary drainage. These technics are proved to heal =
postraumatic biliary fistula without any operative intervention.

Jos=E9 M. Del Pino, MD
Digestive Surgery Service
Hosp. Universitario Ntra. Sra. de Candelaria
Tenerife, Canary Islands, Spain
  ----- Original Message -----=20
  From: SJASMD@aol.com=20
  To: trauma-list@trauma.org=20
  Sent: Tuesday, January 08, 2002 9:02 AM
  Subject: Re: bile fistula

  In a message dated 1/8/2002 1:21:01 AM Eastern Standard Time, =
junpangilinan@yahoo.com writes:

    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

  seems like the fistulogram failed and should be repeated=20
  it showed a connection between the biliary tree and the surface you =
just didnt identify how the contrast media arrived in the biliary tree.=20
  whether there is aplace for nonoperative management depends upon the =
location of the fistula and the condition of the outflow tract of the =
biliary tree. If there is no obstruction you probably can control the =
fistula by drainage
  if the main duct is injured or obstructed, then percutaneous drainage =
wont work

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<HTML><HEAD>
<META http-equiv=3DContent-Type content=3D"text/html; =
charset=3Diso-8859-1">
<META content=3D"MSHTML 6.00.2600.0" name=3DGENERATOR>
<STYLE></STYLE>
</HEAD>
<BODY bgColor=3D#ffffff>
<DIV><FONT face=3DArial size=3D2>Perhaps you must try to perform an ERCP =
wich would=20
be not only diagnostic where the biliary duct injury is, but con allow =
complete=20
biliary diversion to duodenum by plastic endostenting or sphincterotomy =
with=20
nasobiliary drainage. These technics are proved to =
heal&nbsp;postraumatic=20
biliary&nbsp;fistula without any operative intervention.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>Jos=E9 M. Del Pino, MD</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Digestive Surgery Service</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Hosp. Universitario Ntra. Sra. de=20
Candelaria</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Tenerife, Canary Islands, =
Spain</FONT></DIV>
<BLOCKQUOTE=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3DSJASMD@aol.com =
href=3D"mailto:SJASMD@aol.com">SJASMD@aol.com</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Tuesday, January 08, 2002 =
9:02=20
  AM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: bile fistula</DIV>
  <DIV><BR></DIV><FONT face=3Darial,helvetica><FONT=20
  style=3D"BACKGROUND-COLOR: #ffffff" size=3D2>In a message dated =
1/8/2002 1:21:01=20
  AM Eastern Standard Time, <A=20
  href=3D"mailto:junpangilinan@yahoo.com">junpangilinan@yahoo.com</A>=20
  writes:<BR><BR><BR>
  <BLOCKQUOTE=20
  style=3D"PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #0000ff 2px =
solid; MARGIN-RIGHT: 0px"=20
  TYPE=3D"CITE">Suspecting a biliary-cutaneous fistula a soft Fr =
10<BR>rubber=20
    catheter was inserted into the cutaneous<BR>opening and a =
fistulogram was=20
    done. This revealed<BR>opacification of the gall bladder and intra=20
    hepatic<BR>ducts. There was no spillage of contrast into =
the<BR>peritoneal=20
    cavity</BLOCKQUOTE><BR><BR>seems like the fistulogram failed and =
should be=20
  repeated <BR>it showed a connection between the biliary tree and the =
surface=20
  you just didnt identify how the contrast media arrived in the biliary =
tree.=20
  <BR>whether there is aplace for nonoperative management depends upon =
the=20
  location of the fistula and the condition of the outflow tract of the =
biliary=20
  tree. If there is no obstruction you probably can control the fistula =
by=20
  drainage<BR>if the main duct is injured or obstructed, then =
percutaneous=20
  drainage wont work<BR></BLOCKQUOTE></FONT></FONT></BODY></HTML>

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