Preliminary Report of Percutaneous Cholecystostomy as Diagnosis and Treatment of Biliary Tract Trauma

Abstract

Cholecystostomy in non-operative management of biliary fistula after blunt liver injury could be an effective, simple and safe first-line procedure in the diagnostic and therapeutic approach of post-traumatic biliary tract injuries.

Case of gunshot injury to the liver by a hand-made modified sniper bullet: organ-preserving surgical management with damage control tactics and transpapillary biliary decompression

“…In addition, damage control tactics was used for acute cholecystitis, which was treated with the help of cholecystostomy. This observation is consistent with Cazauran et al, suggesting cholecystostomy instead of cholecystectomy for high-risk surgical patients [31].…”

“…Similar to other studies, we have also diagnosed a partial EBF, caused by the failure of the drainage function of the endobiliary stent [10,16,20]. Similar to our previous report and other studies, we have not detected any evidence of an EBF relationship to the specific clinical features of this patient [1,10,31].…”

“…Therefore, liver packing as a part of damage control tactics was performed at lower levels of military medical care, which is also confirmed by our earlier reports and is in line with other studies which suggest anatomical hepatic resection in such cases only at Level IV [1,2,6,30]. It should be noted that nonoperative management is frequently used for the treatment of GSW to the liver [31]. However, similar to other studies, we did not apply such tactics in this case because of the unstable hemodynamics of the patient [10,28,32].…”

“…In this study, we presented an effective approach to biliary decompression in the case of multiple GSWs to the liver associated with a bile leak and EBF. Biliary decompression can be achieved by the application of various techniques and their combinations, such as EST, biliary stenting, nasobiliary bile drainage [11,16,17,31]. The application of one or several of the above-mentioned methods is aimed at minimizing the pressure gradient between the biliary system and the lumen of the duodenum in order to provide bile flow into the digestive tract but not into the EBF.…”

Future Perspectives on Radiomics in Acute Liver Injury and Liver Trauma

“…Moreover, during the monitoring, the radiologists’ experience must also concern persistent bleeding, haemobilia, and biliary fistula [ 96 , 97 , 98 , 99 , 100 , 101 ]. Consequently, these complications must be treated to avoid cole-peritoneum and sepsis, which can also worsen the volume injured [ 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ].…”