TRAUMATISMO DE VESICULA BILIAR Y VAS BILIARES

DANIEL ACEVEDO GUZMN R2CGTRAUMATISMO DE VESICULA BILIAR Y VAS BILIARESEpidemiologaLesiones del rbol biliarYatrognicas 95%Trauma 5%

Trauma abdominalVescula biliar 3% a 5% Vas biliares 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) 47Trauma penetrante (89%)Arma de fuego 88%Arma balnca 12%

Trauma cerrado(11%)Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, Journal of Trauma Management & Outcomes 2010Anatoma

Lesin de Vescula y Vas BiliaresLesiones asociadas

Estado de shock

12% de las lesiones de la va biliar pueden pasar desapercibidas en la primera ciruga

Maniobra de CatellDiagnsticoEl diagnstico es transoperatorio

Se encuentra en conjunto con lesines asociadas:Hepticas (83-91%)Vascular (67%)Duodenal (54%)Esplenicas (54%)Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, Journal of Trauma Management & Outcomes 2010La fuga biliar puede ocasionar sintomatologa BilioperitoneoDolor abdominalAumento 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) 47Lavado peritoneal diagnsticoCaractersticas 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) 47TomografaDatos sugestivos:Dilatacin ductal Colecciones periportales

No muestran el sitio de lesinTeck 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

UltrasonidoNo muy til en diagnstico

No distingue colecciones Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, Journal of Trauma Management & Outcomes 2010CPREMtodo de diagnstico del conducto biliar

Sitio de lesin

Laceraciones FugaNikhil 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, 2008Vescula biliarLesiones de vescula

Contusin: Hematoma intramuralPerforacin: Ruptura de vescula biliar Avulsin :Parcial: parcialmente separada del lecho Completa: totalmente separade del lecho Total: vesicula biliar libre en abdomenPavlidis 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 KjossevPavlidis 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, 5:392Colecistectoma abierta Lesin de conducto csticoLesin de arteria heptica derechaColecistectoma laparoscpoica en trauma penetrante

Colecistorrafia Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, Journal of Trauma Management & Outcomes 2010Conducto biliarFisiopatologa de la lesin:

Compresin del sistema biliar con columna vertebral

Compresin externa de vesculaAumento de presin intraductalTeck 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) 47Conducto BiliarSe han descrito 4 categoras en la lesin de conducto biliar: Avulsin del conducto cstico o pequea laceracin. Seccin sin perdida de tejidoDefecto extenso en la paredPerdida de segmento ductalTeck 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 hemorragiaTeck 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) 47No estables:Empaquetamiento Drenaje (jackson Pratt)

Mas estables:sonda en TTeck 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) 47Pequeas laceraciones Cierre primarioSonda en T

Estenosis: Conducto csticoPared de la vesicularChad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, Journal of Trauma Management & Outcomes 2010Seccin de conducto biliar sin prdida significativa de tejido:

Anastomosis termino-terminal55% estenosis

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, Journal of Trauma Management & Outcomes 2010Los 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, 2008Colecistoyeyunostoma + ligadura distal del conducto

Lesin de algn conducto hepticoLa ligadura produce involucin del lbulo

Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, Journal of Trauma Management & Outcomes 2010Lesin del conducto biliar ampular o intrapancretico

Pancreatoduodenectoma Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, 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.SourceDepartment 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 extrahepaticbileduct 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 ofbileduct trauma. Hepatobiliary Pancreat Dis Int.2003 May;2(2):295-9.

Thomson SR,Bade PG. Penetratingbileduct trauma. Injury.1989 Jul;20(4):215-6.