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bile fistula

trauma-list@trauma.org trauma-list@trauma.org
Tue, 8 Jan 2002 23:07:52 EST 

I would begin with upper GI and small bowel follow thru to confirm your not 
dealing with an occult duodenal lesion. If negative, I would recomend ERCP 
and Stent placement if a bile duct leak is identified or not as it may help 
decompress the biliary tree in the face of a parenchymal leak (albeit 
anectdotal). In either case, npo, parenteral nutrition, ngt decompression 
accompanied with Octreotide 100ug Sub Q q8(somatostatin analog) has given us 
excellent results for non-op management of fistulas as well as duodenal 
ulcer. It usually takes 48-72 hrs to see initial results.
dave nap