Biloma secondary to blunt liver trauma in a pediatric patient: case report

Liver is the organ most frequently injured after blunt or penetrating abdominal trauma, being in pediatrics a pathology that has an increasing incidence; Non-operative management is the hallmark of treatment, however cases of secondary biliary leakage have been described, which may affect the intrahepatic or extrahepatic track. A male 8 years old, with blunt trauma in the right hypochondrium, presenting acute abdomen and hemodynamic instability, requiring exploratory laparotomy with a grade III liver injury in VI and VII hepatic segments. Four weeks after discharge, he presented as a complication a giant biloma in VII and VIII hepatic segments, performing percutaneous drainage guided by ultrasound. The incidence of biliary complications related to hepatic trauma is low, 4% in pediatric patients, dividing into bilomas or biliary fistulas; the presentation of biliary leakage is very non-specific and early diagnosis difficult; in the bilomas, the tomography allows to define precisely its size, nature, distribution and regional anatomy in relation to adjacent structures, as well as underlying cause. The approach of choice is percutaneous or endoscopic drainage, with surgical management being the last option

A case report on choledochoduodenal fistula: how to suspect this unusual entity?

A choledochoduodenal fistula is an abnormal connection between the common bile duct and the duodenum, which are associated with a history of problems in the common bile duct. It has appeared in 0.74% of patients submitted for biliary tract surgery. The most frequent symptoms of non-obstructive enteric biliary fistulas are: epigastric pain, cholangitis (80.91%), jaundice (54,.26%), fever (50.69%), nausea and/or vomiting (10.30%), abdominal distension (0.39%), asymptomatic (0.11%), and diarrhea (0.11%). Diagnostic imaging methods provide the data of greatest interest in revealing the presence of air in the bile duct. This method, as well as barium reflux under the biliary tree in contrasted studies and in ERCP, reveal the fistulous tract and its location. Neither the prevalence, nor the clinical characteristics that pertain to its presentation, are well known among our population. Possible treatments for this illness include conservative treatment with medication, endoscopic sphincterotomy, and surgical therapy