Is Bowel Rest a Prerequisite for Successful Outcome in Nonoperative Management of Extrahepatic Bile Duct Blunt Injury in Children?

Abstract

Extrahepatic bile duct injury resulting from blunt abdominal trauma in children is not common. Nonoperative management has become the standard of care. During a two-year period from January 2005 to December 2006, we treated 1015 pediatric traumas. Of those, 103 were blunt abdominal trauma. Only two patients had injury to the extrahepatic bile ducts. Both cases were managed nonoperatively; however, the clinical presentation required a different approach. Facilitation of bile flow by means of sphincterotomy, or putting a transampullary stent, had the most significant impact on successful outcome. Bowel rest did not influence outcome. Therefore nonoperative management of blunt extrahepatic bile duct blunt injuries in children should be based on ensuring adequate bile flow. Bowel rest does not seem to be a prerequisite for successful outcome.

Index Word: Blunt abdominal trauma; extrahepatic bile duct injury; nonoperative.