Traumatic bile leak in war-injured Syrians: five patients treated by ERCP

Khamaysi, Iyad; Suissa, Alain; Yassin, Kamel; Gralnek, Ian M.

doi:10.1055/s-0034-1392656

Cited by 5 publications

(6 citation statements)

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“…In total, 38 publications met the inclusion criteria of this systematic review as shown in Figure 1 10–47. There was no other systematic review on this area of research found.…”

Section: Resultsmentioning

confidence: 99%

“…Seven papers did not indicate the gender of the casualties 10 11 15 23 26 29 40. Eight papers met the eligibility criteria and had specific data for children aged less than 18 years 12 13 19 24 27 44–46. Nine other papers were excluded due to being specific to childhood trauma 18 30–33 47.…”

Section: Resultsmentioning

confidence: 99%

“…The results are shown in Table 2. Twenty-nine papers recorded the mechanism of injury, of which 18 were not exclusive to the mechanism therefore allowing comparison 4 5 9 10 12 15 17–19 22 24 26 32 34–37…”

Section: Resultsmentioning

confidence: 99%

“…Of the 30 papers which documented the site of injury, only three were not specific to the injured anatomical region, allowed subcategorisation according to the AIS regions and were not case studies 12 16 27. Eighteen papers were site specific 10 13 18–22 24–26 28 29 33 38 39 42 44 46. Four could not be categorised in relation to the AIS 14 31 43 45.…”

Section: Resultsmentioning

confidence: 99%

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Syrian Civil War: a systematic review of trauma casualty epidemiology

McIntyre¹

2020

BMJ Mil Health

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BackgroundThe Syrian Civil War has caused over 400 000 traumatic deaths. Understanding the nature of war casualties is crucial to deliver healthcare improvement. Historic regional conflicts and Syrian mortality data have been characterised by blast injuries. The aim of this novel review is to assess the trauma epidemiology of Syrian Civil War casualties from the perspective of healthcare facilities.MethodsThis review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Studies addressing Syria, trauma and war were investigated. Eligibility criteria included being conducted from a healthcare facility, published in English and peer reviewed. The outcomes were demography, mechanism of injury and anatomical injury site.Results38 papers satisfied the eligibility criteria. 13 842 casualties were reported across the entire data set. Casualties were 88.8% male (n=4035 of 4544). Children contributed to 16.1% of cases (n=398 of 2469). Mortality rate was 8.6% (n=412 of 4774). Gunshot wound was the most common mechanism of injury representing 66.3% (n=7825 of 11799). Head injury was the most common injured site at 26.6% (n=719 of 2701).ConclusionsThis conflict has a distinct trauma profile compared with regional modern wars. The prevalence of gunshot wounds represents a marked change in mechanism of injury. This may be related to higher mortality rate and proportion of head injuries identified. This review cannot correlate mechanism of injury, demographics or injuries sustained to outcomes. The quality of data from the included studies lacked standardisation; future research and consistent reporting tools are required to enable further analysis.

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“…In total, 38 publications met the inclusion criteria of this systematic review as shown in Figure 1 10–47. There was no other systematic review on this area of research found.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Syrian Civil War: a systematic review of trauma casualty epidemiology

McIntyre¹

2020

BMJ Mil Health

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“…Conservative treatment includes arteriography and selective embolization, computed tomography guided drainage of collections and ERCP with sphincterotomy and biliary stent placement (5,20) . Recent studies have shown that ERCP is an effective treatment for bile leaks secondary to traumatic liver injuries, with more than 80% success rate (21) . In all five cases of bile leak secondary to hepatic trauma ERCP was successfully used in treatment with a decrease in abdominal surgical drainage volume after the procedure, and cessation of the drainage in 1-7 (minimum 1 and maximum 7) days, concluding that in our casuistic ERCP was effective and safe to treat bile leaks after hepatic complex trauma.…”

Section: Discussionmentioning

confidence: 99%

Sphincterotomy Alone Versus Sphincterotomy and Biliary Stent Placement in the Treatment of Bile Leaks: 10 Year Experience at a Quaternary Hospital

Flumignan

Sachdev

Nunes

et al. 2021

Arq. Gastroenterol.

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BACKGROUND: Hepatobiliary surgery and hepatic trauma are frequent causes of bile leaks and this feared complication can be safely managed by endoscopic retrograde cholangiopancreatography (ERCP). The approach consists of sphincterotomy alone, biliary stenting or a combination of the two but the optimal form remains unclear. OBJECTIVE: The aim of this study is to compare sphincterotomy alone versus sphincterotomy plus biliary stent placement in the treatment of post-surgical and traumatic bile leaks. METHODS: We retrospectively analyzed 31 patients with the final ERCP diagnosis of “bile leak”. Data collected included patient demographics, etiology of the leak and the procedure details. The treatment techniques were divided into two groups: sphincterotomy alone vs. sphincterotomy plus biliary stenting. We evaluated the volume of the abdominal surgical drain before and after each procedure and the number of days needed until cessation of drainage post ERCP. RESULTS: A total of 31 patients (18 men and 3 women; mean age, 51 years) with bile leaks were evaluated. Laparoscopic cholecystectomy was the etiology of the leak in 14 (45%) cases, followed by conventional cholecystectomy in 9 (29%) patients, hepatic trauma in 5 (16%) patients, and hepatectomy secondary to neoplasia in 3 (9.7%) patients. The most frequent location of the leaks was the cystic duct stump with 12 (38.6%) cases, followed by hepatic common duct in 10 (32%) cases, common bile duct in 7 (22%) cases and the liver bed in 2 (6.5%) cases. 71% of the patients were treated with sphincterotomy plus biliary stenting, and 29% with sphincterotomy alone. There was significant difference between the volume drained before and after both procedures (P<0.05). However, when comparing sphincterotomy alone and sphincterotomy plus biliary stenting, regarding the volume drained and the days needed to cessation of drainage, there was no statistical difference in both cases (P>0.005). CONCLUSION: ERCP remains the first line treatment for bile leaks with no difference between sphincterotomy alone vs sphincterotomy plus stent placement.

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Application of Damage Control Tactics and Transpapillary Biliary Decompression for Organ-Preserving Surgical Management of Liver Injury in Combat Patient

Хоменко¹,

Tsema

Humeniuk³

et al. 2021

Military Medicine

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The combat penetrating gunshot injury is frequently associated with damage to the liver. Bile leak and external biliary fistula (EBF) are common complications. Biliary decompression is commonly applied for the management of EBF. Also, little is known about the features of combat trauma and its management in ongoing hybrid warfare in East Ukraine. A 23-year-old male was diagnosed with thoracoabdominal penetrating gunshot wound (GSW) by a high-energy multiple metal projectile. Damage control tactics were applied at all four levels of military medical care. Biliary decompression was achieved by endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and the placement of biliary stents. Occlusion of the stent was treated by stent replacement, and scheduled ERCP was performed. Partial EBF was diagnosed from the main wound defect of the liver and closed without surgical interventions on the 34th day after the injury. A combination of operative and nonoperative techniques for the management of the combat GSW to the liver is effective along with the application of damage control tactics. A scheduled ERCP application is an effective approach for the management of EBF, and liver resection could be avoided. A successful biliary decompression was achieved by the transpapillary intervention with the installation of stents. Stent occlusion could be diagnosed in the early post-traumatic period, which is effectively managed by scheduled ERCP as well as stent replacement with a large diameter as close as possible to the place of bile leak.

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Traumatic bile leak in war-injured Syrians: five patients treated by ERCP

Abstract: Khamaysi Iyad et al. Traumatic bile leak in war-injured Syrians … Endoscopy 2015; 47: E426-E427 Cases and Techniques Library (CTL) E427

Cited by 5 publications

References 1 publication

Syrian Civil War: a systematic review of trauma casualty epidemiology

Syrian Civil War: a systematic review of trauma casualty epidemiology

Sphincterotomy Alone Versus Sphincterotomy and Biliary Stent Placement in the Treatment of Bile Leaks: 10 Year Experience at a Quaternary Hospital

Application of Damage Control Tactics and Transpapillary Biliary Decompression for Organ-Preserving Surgical Management of Liver Injury in Combat Patient

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