Delayed endoscopic management of a high-grade common bile duct injury: A case report

• Published in: Journal of pediatric surgery case reports 2019-12, Vol.51, p.101314, Article 101314
• Main Authors: Marks, Robyn M., Potter, D. Dean
• Format: Article
• Language: English
• Subjects: Bile duct injury; Non-operative management; Pancreatic injury
• ISSN: 2213-5766; 2213-5766
• DOI: 10.1016/j.epsc.2019.101314

Although uncommon, pancreas and bile duct injuries can yield devastating outcomes following blunt abdominal trauma. Optimal management of these injuries is widely debated, but historically, surgical repair has been the recommended treatment for high-grade lesions. More recently, there has been interest in non-operative and endoscopic management strategies as less invasive alternatives, especially for pediatric patients. A successful outcome for any of these treatment options depends on several factors including proper diagnosis, stability of the patient, and time from diagnosis to treatment intervention. In this case, we present a 13 year old male who sustained a grade IV pancreatic injury with Grade V common bile duct transection in a remote area of North Dakota. The patient was promptly diagnosed and stabilized with drains. An early decision for endoscopic management was made and successfully carried out several months from the initial injury. The patient has since gone over one year without secondary complications. This case highlights the benefits of a rural trauma system that allowed for cutting edge management for high-grade traumatic injuries.