Pediatric Trauma Society

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Management of a Traumatic Common Bile Duct Avulsion with an Endoscopic and Transhepatic Rendezvous Procedure
Paul McGaha, II, MD1; William Vanlandingham, MD1; John Maple, DO1; Jeremy Johnson, MD2
1University of Oklahoma Health Science Center, Oklahoma City, OK; 2Children's Hospital at University of Oklahoma Health Sciences Center, Oklahoma City, OK

Background: Isolated injuries to the common bile duct (CBD) following blunt abdominal trauma in pediatric patients are rare. We report a case of complete avulsion of the CBD and subsequent non-operative management using a rendezvous procedure performed via endoscopic and transhepatic approaches. Our patient is an 11 year old healthy male who was involved in a golf cart accident. An initial CT scan showed a high-grade pancreatic head laceration.

Methods: One week after admission, follow-up imaging revealed a new complex abdominal fluid collection. A 10 Fr percutaneous drain placed into the right upper quadrant under ultrasound guidance confirmed a biloma. Imaging during endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a high grade injury to the peri-ampullary CBD compatible with a complete avulsion. Restoration of duct continuity was attempted during ERCP and subsequent percutaneous transhepatic cholangiography (PTC), but neither technique was successful in bridging the disruption. An 8.5 Fr transhepatic drain was placed into the proximal CBD during the PTC.

Results: Several days later during a cooperative rendezvous procedure, an endoscopically cannulated guidewire was captured with a snare that was passed transhepatically into the CBD, permitting placement of an 8 Fr percutaneous drain that traversed the avulsion and terminated in the duodenum. The patient clinically improved in the ensuing weeks and ultimately required no operative intervention. This is the first reported case of a biliary rendezvous procedure performed in a pediatric patient.

Conclusion: Pediatric patients with a complete CBD avulsion may be successfully managed with endoscopic and transhepatic rendezvous technique, avoiding major surgery.

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