TRAUMATISMO DE VESICULA BILIAR Y VAS BILIARES

DANIEL ACEVEDO GUZMN R2CG

Epidemiologa
Lesiones del rbol biliar
Yatrognicas Trauma

95% 5%

Trauma abdominal
Vescula biliar Vas biliares

3% a 5% 0.5%

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) 47

 Trauma penetrante
Arma de fuego Arma balnca

(89%)
88% 12%

Trauma cerrado (11%)

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to the Gallbladder, Journal of Trauma Management & Outcomes 2010

Anatoma

Lesin de Vescula y Vas Biliares

Lesiones asociadas Estado de shock 12% de las lesiones de la va biliar pueden pasar

desapercibidas en la primera ciruga

Maniobra de Catell

Diagnstico
El diagnstico es transoperatorio Se encuentra en conjunto con lesines

asociadas:
Hepticas

(83-91%) (54%) (54%)

Vascular (67%)
Duodenal Esplenicas

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to the Gallbladder, Journal of Trauma Management & Outcomes 2010

 La fuga biliar puede ocasionar sintomatologa

Bilioperitoneo Dolor abdominal Aumento de volumen abdominal

Puede pasar hasta semanas para su diagnstico

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) 47

Lavado peritoneal diagnstico

Caractersticas biliares (no especfico)
Lesin heptica Lesin 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) 47

Tomografa
Datos sugestivos:
Dilatacin ductal Colecciones periportales

No muestran el sitio de lesin

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) 47

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) 47

Ultrasonido
No muy til en diagnstico No distingue colecciones

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to the Gallbladder, Journal of Trauma Management & Outcomes 2010

CPRE
Mtodo de diagnstico del conducto biliar Sitio de lesin Laceraciones
Fuga

Nikhil P. Jaik,1 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. Jaik,1 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

Vescula biliar
Lesiones de vescula
Contusin: Hematoma intramural Perforacin: Ruptura de vescula biliar Avulsin : 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, 5:392

Clasificacin 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, 5:392

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, 5:392

 Colecistectoma abierta
Lesin de conducto cstico Lesin de arteria heptica derecha

Colecistectoma laparoscpoica en trauma

penetrante
Colecistorrafia

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to the Gallbladder, Journal of Trauma Management & Outcomes 2010

Conducto biliar
Fisiopatologa de la lesin:
Compresin del sistema biliar con columna

vertebral
Compresin externa de vescula Aumento de presin 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) 47

Conducto Biliar
Se han descrito 4 categoras en la lesin de

conducto biliar:
Avulsin del conducto cstico o pequea laceracin. Seccin 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) 47

Lesin de Conducto biliar

En el paciente estable la reparacin definitiva es

preferida.
La lesin 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 traum A successful management strategy, Injury Extra 42 (2011) 47

 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) 47

 Pequeas laceraciones
Cierre primario Sonda en T

Estenosis:
Conducto cstico Pared de la vesicular

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to the Gallbladder, Journal of Trauma Management & Outcomes 2010

 Seccin de conducto biliar sin prdida

significativa de tejido:
Anastomosis termino-terminal 55% estenosis

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to the Gallbladder, Journal of Trauma Management & Outcomes 2010

 Los defectos extensos de pared y perdida de

segmentos del ducto:

Astomosis bilioentricas. Hepatoyeyunostoma en Y de Roux con colecistectoma + colocaicn de tubo en T Tcnicas con parches

Nikhil P. Jaik,1 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

 Colecistoyeyunostoma + ligadura distal del

conducto
Lesin de algn conducto heptico
La ligadura produce involucin del lbulo

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to the Gallbladder, Journal of Trauma Management & Outcomes 2010

 Lesin del conducto biliar ampular o

intrapancretico
Pancreatoduodenectoma

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to the Gallbladder, Journal of Trauma Management & Outcomes 2010

Nikhil P. Jaik,1 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 Mar;76(3):256-8. Surgical options in traumatic injury to the extrahepatic biliary tract. Bade PG, Thomson SR, Hirshberg A, Robbs JV. Source Department of Surgery, University of Natal, Durban, South Africa.

Am J Surg. 1985 Dec;150(6):705-9. Management of traumatic injuries to the extrahepatic biliary ducts. Feliciano DV, Bitondo CG, Burch JM, Mattox KL, Beall AC Jr, Jordan GL Jr.

J Trauma. 1985 Sep;25(9):833-7. Extrahepatic biliary tract injury: operative management plan. Posner MC, Moore EE.

World J Surg. 2001 Oct;25(10):1313-6. Complications following repair of extrahepatic bile duct injuries after blunt abdominal trauma. Rodriguez-Montes JA, Rojo E, Martn LG.

 Xu J, Geng ZM, Ma QY. Microstructural and

ultrastructural changes in the healing process of bile duct trauma. Hepatobiliary Pancreat Dis Int. 2003 May;2(2):295-9.
Thomson SR, Bade PG. Penetrating bile duct

trauma. Injury. 1989 Jul;20(4):215-6.