Traumatic biliary tract
injuries in children are rare but may result in significant morbidity. The objective of this study was to review the occurrence of traumatic biliary tract
injuries in children, management strategies, and outcome.
METHODS: We conducted a retrospective review of patients with biliary tract injury using the
trauma registry at our level 1 pediatric trauma center from 2002-2012.
RESULTS: Twelve out of 13,582
trauma patients were identified, representing 0.09% of all
trauma patients. All were secondary to blunt
trauma. Mean age was 9.7 years [range 4-15], and mean Injury Severity Score was 31 ± 14, with overall survival of 92%. Biliary
injuries included major ductal injury (6), minor ductal injury with biloma (4), gallbladder injury (2), and intrahepatic ductal injury (1). Major ductal
injuries were managed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary
stent (5) and Roux-en-Y hepaticojejunostomy (1). Associated gallbladder injury was managed by
cholecystectomy. In addition, the associated biloma was managed with percutaneous drainage (7), laparoscopic drainage (2), or during
laparotomy (3). Two patients with ductal
injuries developed late
strictures after initial management with ERCP and
stent placement. One of the two patients ultimately required a left
hepatectomy, and the other has been managed conservatively without evidence of
cholangitis. Two patients required placement of additional drains and prolonged
antibiotics for
superinfection following biloma drainage.
CONCLUSION: Biliary tract
injuries are rare in children, and many are amenable to adjunctive
therapy, including ERCP and biliary
stent placement with or without placement of a peritoneal drain. Patients with a discrete ductal injury are at higher risk for
stricture and require close follow up. Hepaticojejunostomy remains the definitive repair for large extrahepatic biliary tract
injuries or transections.