Endoscopic ultrasonography-guided hepaticogastrostomy as a bridge to the definitive biliary reconstruction in a pediatric patient with left hepatic duct disruption secondary to blunt liver trauma

• Main Authors: Kaori Ito (Author), Takao Itoi (Author), Seisuke Sakamoto (Author), Mureo Kasahara (Author), Yasufumi Miyake (Author), Tetsuya Sakamoto (Author)
• Format: Book
• Published: Elsevier, 2020-12-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Case report: Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is a minimally invasive technique for biliary system drainage that is used in adult patients with biliary obstruction whose papilla of Vater cannot be accessed. We report a pediatric patient who developed complete obstruction of left hepatic duct associated with liver injury and underwent EUS-HGS as a bridge to the definitive biliary reconstruction. A 7-year-old boy sustained a liver injury (Grade IV) developed bile peritonitis post-traumatic day 17 and underwent perihepatic drainage followed by endoscopic retrograde cholangiopancreatography, which revealed persistent bile leakage from B8. The left biliary system was not visible. A 7-Fr plastic stent was placed into the right biliary system, but 1 week later the patient developed diffuse dilatation of the left biliary system due to complete obstruction of left hepatic duct. EUS-HGS was performed to drain the left biliary system. A dilated bile duct (B2) was accessed using a needle through the EUS probe. A 7-Fr plastic stent was placed into B2 over the guidewire. Eight months later, he underwent elective exploratory laparotomy and hepaticojejunostomy by pediatric hepatobiliary surgeons. Conclusion: Temporarily draining the biliary system by EUS-HGS is a viable option prior to definitive biliary reconstructive surgery.

Item Description

2213-5766
10.1016/j.epsc.2020.101685