List Archives

Wed, 9 Jan 2002 08:25:23 +0100

We would suggest ERCP. In case of intrahepatic duct lesion stent placement;
extrahepatic lesion stent or PTC drainage and reconstruction after +/- 6
weeks. Cholecystectomy if the gallbladder is injured.

J.C. Goslings
O.R.C. Busch
Trauma Unit and HPB Unit, Dept. Surgery
Acad. Med. Centre Amsterdam.

----- Original Message -----
From: "Honorio Ma. Jr. Pangilinan" <junpangilinan@yahoo.com>
To: <trauma-list@trauma.org>
Sent: Tuesday, January 08, 2002 7:17 AM
Subject: bile fistula

> 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