I traumi chiusi dei dotti epatici: un difficile inquadramento diagnostico-terapeutico

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COD: 2002_04_403-408 Categorie: ,

P. Veroux, A. Buffone, M. Veroux, M.S. Macarone, D. Cappello, M. Valvo, D. La Boccetta

Ann. Ital. Chir., LXXIII, 4, 2002

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Traumatic injuries of left and right hepatic ducts are rare, with about 40 cases reported in literature. Preoperative diagnosis is difficult, so that up to 40% of lesions may be undetected at laparotomy. Prompt diagnosis could preserve by high morbidity rate of such injuries. The extremely widespread and routine use of ERCP as well as intraoperative cholangiography may allow reducing dramatically the diagnostic time lag and the percentage of lesions formerly undetected by laparotomy. Therapeutic options are extremely variable. On the basis of the experiences reported for the treatment of iatrogenic lesions of the biliary tract, reconstruction by jejunal Roux-en-Y loop biliodigestive anastomosis is preferred, whenever lacerations of an hepatic duct appear to be complete or nearly so, on account of the high incidence of stenosis and late complications, detected in case of termino-terminal direct biliary anastomosis.

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