1. 1. TRAUMATISMO DE VESICULABILIAR Y VAS BILIARESDANIEL ACEVEDO GUZMN R2CG
2. 2. Epidemiologa Lesiones del rbol biliar Yatrognicas 95% Trauma 5% Trauma abdominal Vescula biliar3% a 5% Vas biliares0.5%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
3. 3. Trauma penetrante (89%) Arma de fuego88% Arma balnca12% Trauma cerrado (11%) Chad G Ball*1, Elijah Dixon1, A decade of experience with injuries to the Gallbladder, Journal of Trauma Management & Outcomes 2010
4. 4. Anatoma
5. 5. Lesin de Vescula y VasBiliares Lesiones asociadas Estado de shock 12% de las lesiones de la va biliar pueden pasar desapercibidas en la primera ciruga Maniobra de Catell
6. 6. Diagnstico El 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 the Gallbladder, Journal of Trauma Management & Outcomes 2010
7. 7. La fuga biliar puede ocasionar sintomatologa Bilioperitoneo Dolor abdominal Aumento de volumen abdominal Puede pasar hasta semanas para su diagnsticoTeck 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
8. 8. Lavado peritoneal diagnstico Caractersticas biliares (no especfico) Lesin heptica Lesin de intestino delgadoTeck 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
9. 9. Tomografa Datos 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
10. 10. 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
11. 11. Ultrasonido No muy til en diagnstico No distingue coleccionesChad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, Journal of Trauma Management & Outcomes 2010
12. 12. CPRE Mtodo 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 ExtrahepaticHepatic Ductal Injuries due to Blunt Trauma: Diagnostic and Treatment Algorithms, HPB Surgery, 2008
13. 13. Nikhil P. Jaik,1 Brian A. Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of ExtrahepaticHepatic Ductal Injuries due to Blunt Trauma: Diagnostic and Treatment Algorithms, HPB Surgery, 2008
14. 14. 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 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
15. 15. Clasificacin por Losanoff andKjossev 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
16. 16. 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
17. 17. 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
18. 18. Conducto biliar Fisiopatologa de la lesin: Compresin del sistema biliar con columna vertebral Compresin externa de vescula Aumento 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) 47
19. 19. 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 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
20. 20. 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
21. 21. No 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) 47
22. 22. 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
23. 23. 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
24. 24. 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 parchesNikhil P. Jaik,1 Brian A. Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of ExtrahepaticHepatic Ductal Injuries due to Blunt Trauma: Diagnostic and Treatment Algorithms, HPB Surgery, 2008
25. 25. Colecistoyeyunostoma + ligadura distal del conducto Lesin de algn conducto heptico La ligadura produce involucin del lbuloChad G Ball*1, Elijah Dixon1, A decade of experience with injuries to theGallbladder, Journal of Trauma Management & Outcomes 2010
26. 26. 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
27. 27. Nikhil P. Jaik,1 Brian A. Hoey Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of ExtrahepaticHepatic Ductal Injuries due to Blunt Trauma: Diagnostic and Treatment Algorithms, HPB Surgery, 2008
28. 28. 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.
29. 29. 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.
30. 30. J Trauma. 1985 Sep;25(9):833-7.Extrahepatic biliary tract injury: operative management plan.Posner MC, Moore EE.
31. 31. World J Surg. 2001 Oct;25(10):1313-6.Complications following repair of extrahepatic bile duct injuries afterblunt abdominal trauma.Rodriguez-Montes JA, Rojo E, Martn LG.
32. 32. 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.