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Endoscopic treatment of bile leak caused by gunshot injury
ENDOSCOPIC TREATMENT OF BILE LEAK CAUSED BY GUNSHOT INJURY
A A 39-year-old man sustained multiple 0.22-caliber gunshot wounds to the abdomen. Urgent laparotomy revealed a nonbleeding laceration to segment 6 of the liver without apparent bile leak. A bleeding renal laceration and colonic perforation were also found and repaired. No bullets were found at laparotomy. Bile-stained fluid continued to drain from a subhepatic drain, and the patient developed jaundice that steadily increased along with elevated levels of alkaline phosphatase, gamma-glutamyl transpeptidase, and alanine aminotransferase. Endoscopic retrograde cholangiography demonstrated a high-grade leak from a radical of the left intrahepatic duct along with 3 retained bullets (A). Sphincterotomy was performed and a 9-cm, 10F plastic stent was
778
GASTROINTESTINAL ENDOSCOPY
B inserted into the bile duct, which resulted in good drainage of contrast from the biliary tree (B). Drainage of bile from the subhepatic drain stopped completely by 48 hours after stent placement, and the liver function tests returned to normal. The patient made a full recovery. Although he was scheduled to return for removal of the stent 6 weeks later, the patient failed to keep this appointment. Nicolas De Luca, BSc, MRCP(UK), FRACP Michael Bourke, FRACP Stephen J. Williams, MD, FRACP Endoscopy Unit Westmead Hospital Westmead, NSW, Australia doi:10.1067/mge.2001.115014
VOLUME 53, NO. 7, 2001
A A 39-year-old man sustained multiple 0.22-caliber gunshot wounds to the abdomen. Urgent laparotomy revealed a nonbleeding laceration to segment 6 of the liver without apparent bile leak. A bleeding renal laceration and colonic perforation were also found and repaired. No bullets were found at laparotomy. Bile-stained fluid continued to drain from a subhepatic drain, and the patient developed jaundice that steadily increased along with elevated levels of alkaline phosphatase, gamma-glutamyl transpeptidase, and alanine aminotransferase. Endoscopic retrograde cholangiography demonstrated a high-grade leak from a radical of the left intrahepatic duct along with 3 retained bullets (A). Sphincterotomy was performed and a 9-cm, 10F plastic stent was
778
GASTROINTESTINAL ENDOSCOPY
B inserted into the bile duct, which resulted in good drainage of contrast from the biliary tree (B). Drainage of bile from the subhepatic drain stopped completely by 48 hours after stent placement, and the liver function tests returned to normal. The patient made a full recovery. Although he was scheduled to return for removal of the stent 6 weeks later, the patient failed to keep this appointment. Nicolas De Luca, BSc, MRCP(UK), FRACP Michael Bourke, FRACP Stephen J. Williams, MD, FRACP Endoscopy Unit Westmead Hospital Westmead, NSW, Australia doi:10.1067/mge.2001.115014
VOLUME 53, NO. 7, 2001