Endoscopic Retrograde Cholangiopancreatography (ERCP) for the use of Complex Hepatobiliary and Pancreatic Injuries

Maris Jones, MD, Cory Richardson, MD, Matthew Johnson, MD, Charles St. Hill, MD, Louise Shadwick, RN, Nathan Ozobia, MD, FACS

University of Nevada School of Medicine and University Medical Center, Las vegas, NV

Introduction: In critically ill trauma patients with complex liver and pancreatic injuries, ERCP with sphincterotomy and endobiliary or endopancreatic stenting has been used in order to minimize the necessity of high risk surgical interventions. ERCP as an adjunct for Grades III-V hepatic injuries as well as pancreatic injuries has proven to be both diagnostic and therapeutic. Our objective is to evaluate the use of ERCP in complex liver and pancreatic injuries.

Methods: ERCP and sphincterotomy with or without endobiliary/endopancreatic stenting was used in patients with complex hepatic or pancreatic injuries to define the extent of the injury and decompress the biliary or pancreatic system in the acute setting in order to prevent further sequela of these complex injuries. A total of 17 patients were studied with a mechanism of either blunt or penetrating trauma and included those with biliary peritonitis, bilio-cutaneous fistulas, extra- and intra-hepatic bilomas, complex pancreatic injuries, and pancreatico-cutaneous fistulas. A small group of these patients had an open abdomen due to damage control procedures performed initially on admission. Early treatment was made possible by performing the procedure exclusively in the supine position. Data was obtained retrospectively by chart review from 2009-2012. This is a single institution case series.

Results: All sequela of biliary and pancreatic injuries resolved with endobiliary and endopancreatic decompression within 8 weeks. One patient developed post-ERCP pancreatitis which resolved without further intervention in 2 days post-ERCP.

Conclusion: ERCP with endobiliary or endopancreatic stenting for complex liver and pancreaticinjuries is a useful adjunct in the armamentarium of the acute care surgeon. Larger randomized studies are needed to further evaluate the use of ERCP in trauma patients.

Session: Poster Presentation

Program Number: P671

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