Traumatismo de vesicula biliar y vias biliares
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DANIEL ACEVEDO GUZMÁN R2CG TRAUMATISMO DE VESICULA BILIAR Y VÍAS BILIARES
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Transcript of Traumatismo de vesicula biliar y vias biliares
DANIEL ACEVEDO GUZMAacuteN R2CG
TRAUMATISMO DE VESICULA
BILIAR Y VIacuteAS BILIARES
Epidemiologiacutea
Lesiones del aacuterbol biliar
Yatrogeacutenicas 95
Trauma 5
Trauma abdominal
Vesiacutecula biliar 3 a 5
Viacuteas biliares 05
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Trauma penetrante (89)
Arma de fuego 88
Arma balnca 12
Trauma cerrado (11)
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Anatomiacutea
Lesioacuten de Vesiacutecula y Viacuteas
Biliares
Lesiones asociadas
Estado de shock
12 de las lesiones de la viacutea biliar pueden pasar
desapercibidas en la primera cirugiacutea
Maniobra de Catell
Diagnoacutestico
El diagnoacutestico es transoperatorio
Se encuentra en conjunto con lesioacutenes
asociadas
Hepaacuteticas (83-91)
Vascular (67)
Duodenal (54)
Esplenicas (54)
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
La fuga biliar puede ocasionar sintomatologiacutea
Bilioperitoneo
Dolor abdominal
Aumento de volumen abdominal
Puede pasar hasta semanas para su diagnoacutestico
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lavado peritoneal diagnoacutestico
bull Caracteriacutesticas biliares (no especiacutefico)
Lesioacuten hepaacutetica
Lesioacuten de intestino delgado
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Tomografiacutea
Datos sugestivos
Dilatacioacuten ductal
Colecciones periportales
No muestran el sitio de lesioacuten
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Epidemiologiacutea
Lesiones del aacuterbol biliar
Yatrogeacutenicas 95
Trauma 5
Trauma abdominal
Vesiacutecula biliar 3 a 5
Viacuteas biliares 05
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Trauma penetrante (89)
Arma de fuego 88
Arma balnca 12
Trauma cerrado (11)
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Anatomiacutea
Lesioacuten de Vesiacutecula y Viacuteas
Biliares
Lesiones asociadas
Estado de shock
12 de las lesiones de la viacutea biliar pueden pasar
desapercibidas en la primera cirugiacutea
Maniobra de Catell
Diagnoacutestico
El diagnoacutestico es transoperatorio
Se encuentra en conjunto con lesioacutenes
asociadas
Hepaacuteticas (83-91)
Vascular (67)
Duodenal (54)
Esplenicas (54)
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
La fuga biliar puede ocasionar sintomatologiacutea
Bilioperitoneo
Dolor abdominal
Aumento de volumen abdominal
Puede pasar hasta semanas para su diagnoacutestico
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lavado peritoneal diagnoacutestico
bull Caracteriacutesticas biliares (no especiacutefico)
Lesioacuten hepaacutetica
Lesioacuten de intestino delgado
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Tomografiacutea
Datos sugestivos
Dilatacioacuten ductal
Colecciones periportales
No muestran el sitio de lesioacuten
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Trauma penetrante (89)
Arma de fuego 88
Arma balnca 12
Trauma cerrado (11)
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Anatomiacutea
Lesioacuten de Vesiacutecula y Viacuteas
Biliares
Lesiones asociadas
Estado de shock
12 de las lesiones de la viacutea biliar pueden pasar
desapercibidas en la primera cirugiacutea
Maniobra de Catell
Diagnoacutestico
El diagnoacutestico es transoperatorio
Se encuentra en conjunto con lesioacutenes
asociadas
Hepaacuteticas (83-91)
Vascular (67)
Duodenal (54)
Esplenicas (54)
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
La fuga biliar puede ocasionar sintomatologiacutea
Bilioperitoneo
Dolor abdominal
Aumento de volumen abdominal
Puede pasar hasta semanas para su diagnoacutestico
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lavado peritoneal diagnoacutestico
bull Caracteriacutesticas biliares (no especiacutefico)
Lesioacuten hepaacutetica
Lesioacuten de intestino delgado
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Tomografiacutea
Datos sugestivos
Dilatacioacuten ductal
Colecciones periportales
No muestran el sitio de lesioacuten
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Anatomiacutea
Lesioacuten de Vesiacutecula y Viacuteas
Biliares
Lesiones asociadas
Estado de shock
12 de las lesiones de la viacutea biliar pueden pasar
desapercibidas en la primera cirugiacutea
Maniobra de Catell
Diagnoacutestico
El diagnoacutestico es transoperatorio
Se encuentra en conjunto con lesioacutenes
asociadas
Hepaacuteticas (83-91)
Vascular (67)
Duodenal (54)
Esplenicas (54)
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
La fuga biliar puede ocasionar sintomatologiacutea
Bilioperitoneo
Dolor abdominal
Aumento de volumen abdominal
Puede pasar hasta semanas para su diagnoacutestico
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lavado peritoneal diagnoacutestico
bull Caracteriacutesticas biliares (no especiacutefico)
Lesioacuten hepaacutetica
Lesioacuten de intestino delgado
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Tomografiacutea
Datos sugestivos
Dilatacioacuten ductal
Colecciones periportales
No muestran el sitio de lesioacuten
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Lesioacuten de Vesiacutecula y Viacuteas
Biliares
Lesiones asociadas
Estado de shock
12 de las lesiones de la viacutea biliar pueden pasar
desapercibidas en la primera cirugiacutea
Maniobra de Catell
Diagnoacutestico
El diagnoacutestico es transoperatorio
Se encuentra en conjunto con lesioacutenes
asociadas
Hepaacuteticas (83-91)
Vascular (67)
Duodenal (54)
Esplenicas (54)
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
La fuga biliar puede ocasionar sintomatologiacutea
Bilioperitoneo
Dolor abdominal
Aumento de volumen abdominal
Puede pasar hasta semanas para su diagnoacutestico
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lavado peritoneal diagnoacutestico
bull Caracteriacutesticas biliares (no especiacutefico)
Lesioacuten hepaacutetica
Lesioacuten de intestino delgado
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Tomografiacutea
Datos sugestivos
Dilatacioacuten ductal
Colecciones periportales
No muestran el sitio de lesioacuten
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Diagnoacutestico
El diagnoacutestico es transoperatorio
Se encuentra en conjunto con lesioacutenes
asociadas
Hepaacuteticas (83-91)
Vascular (67)
Duodenal (54)
Esplenicas (54)
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
La fuga biliar puede ocasionar sintomatologiacutea
Bilioperitoneo
Dolor abdominal
Aumento de volumen abdominal
Puede pasar hasta semanas para su diagnoacutestico
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lavado peritoneal diagnoacutestico
bull Caracteriacutesticas biliares (no especiacutefico)
Lesioacuten hepaacutetica
Lesioacuten de intestino delgado
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Tomografiacutea
Datos sugestivos
Dilatacioacuten ductal
Colecciones periportales
No muestran el sitio de lesioacuten
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
La fuga biliar puede ocasionar sintomatologiacutea
Bilioperitoneo
Dolor abdominal
Aumento de volumen abdominal
Puede pasar hasta semanas para su diagnoacutestico
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lavado peritoneal diagnoacutestico
bull Caracteriacutesticas biliares (no especiacutefico)
Lesioacuten hepaacutetica
Lesioacuten de intestino delgado
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Tomografiacutea
Datos sugestivos
Dilatacioacuten ductal
Colecciones periportales
No muestran el sitio de lesioacuten
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Lavado peritoneal diagnoacutestico
bull Caracteriacutesticas biliares (no especiacutefico)
Lesioacuten hepaacutetica
Lesioacuten de intestino delgado
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Tomografiacutea
Datos sugestivos
Dilatacioacuten ductal
Colecciones periportales
No muestran el sitio de lesioacuten
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Tomografiacutea
Datos sugestivos
Dilatacioacuten ductal
Colecciones periportales
No muestran el sitio de lesioacuten
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Ultrasonido
No muy uacutetil en diagnoacutestico
No distingue colecciones
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
CPRE
Meacutetodo de diagnoacutestico del conducto biliar
Sitio de lesioacuten
Laceraciones
Fuga
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Vesiacutecula biliar
Lesiones de vesiacutecula
Contusioacuten Hematoma intramural
Perforacioacuten Ruptura de vesiacutecula biliar
Avulsioacuten
Parcial parcialmente separada del lecho
Completa totalmente separade del lecho
Total vesicula biliar libre en abdomen
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Clasificacioacuten por Losanoff and
Kjossev
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Pavlidis et al Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy)
a case report and review of the literature Journal of Medical Case Reports 2011 5392
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Colecistectomiacutea abierta
Lesioacuten de conducto ciacutestico
Lesioacuten de arteria hepaacutetica derecha
Colecistectomiacutea laparoscoacutepoica en trauma
penetrante
Colecistorrafia
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Conducto biliar
Fisiopatologiacutea de la lesioacuten
Compresioacuten del sistema biliar con columna
vertebral
Compresioacuten externa de vesiacutecula
Aumento de presioacuten intraductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Conducto Biliar
Se han descrito 4 categoriacuteas en la lesioacuten de
conducto biliar
Avulsioacuten del conducto ciacutestico o pequentildea laceracioacuten
Seccioacuten sin perdida de tejido
Defecto extenso en la pared
Perdida de segmento ductal
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Lesioacuten de Conducto biliar
En el paciente estable la reparacioacuten definitiva es
preferida
La lesioacuten del conducto biliar debe ser manejada
posterior a control de hemorragia
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
No estables
Empaquetamiento
Drenaje (jackson Pratt)
Mas estables
sonda en T
Teck Wei Tan Li Tserng Teo Ming Terk Chiu Extra-hepatic biliary injury secondary to blunt abdominal trauma
A successful management strategy Injury Extra 42 (2011) 4ndash7
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Pequentildeas laceraciones
Cierre primario
Sonda en T
Estenosis
Conducto ciacutestico
Pared de la vesicular
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Seccioacuten de conducto biliar sin peacuterdida
significativa de tejido
Anastomosis termino-terminal
55 estenosis
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Los defectos extensos de pared y perdida de
segmentos del ducto
Astomosis bilioenteacutericas
Hepatoyeyunostomiacutea en Y de Roux con colecistectomiacutea +
colocaicoacuten de tubo en T
Teacutecnicas con parches
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Colecistoyeyunostomiacutea + ligadura distal del
conducto
Lesioacuten de alguacuten conducto hepaacutetico
La ligadura produce involucioacuten del loacutebulo
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Lesioacuten del conducto biliar ampular o
intrapancreaacutetico
Pancreatoduodenectomiacutea
Chad G Ball1 Elijah Dixon1 A decade of experience with injuries to the
Gallbladder Journal of Trauma Management amp Outcomes 2010
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Nikhil P Jaik1 Brian A Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic
Hepatic Ductal Injuries due to Blunt Trauma Diagnostic and Treatment Algorithms HPB Surgery 2008
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Br J Surg 1989 Mar76(3)256-8
Surgical options in traumatic injury to the extrahepatic biliary tractBade PG Thomson SR Hirshberg A Robbs JV
Source
Department of Surgery University of Natal Durban South Africa
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Am J Surg 1985 Dec150(6)705-9
Management of traumatic injuries to the extrahepatic biliary ductsFeliciano DV Bitondo CG Burch JM Mattox KL Beall AC Jr Jordan GL Jr
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
J Trauma 1985 Sep25(9)833-7
Extrahepatic biliary tract injury operative management planPosner MC Moore EE
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
World J Surg 2001 Oct25(10)1313-6
Complications following repair of extrahepatic bile duct injuries after
blunt abdominal traumaRodriguez-Montes JA Rojo E Martiacuten LG
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
Xu J Geng ZM Ma QY Microstructural and
ultrastructural changes in the healing process
of bile duct trauma Hepatobiliary Pancreat Dis
Int 2003 May2(2)295-9
Thomson SR Bade PG Penetrating bile duct
trauma Injury 1989 Jul20(4)215-6
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