6 Non-operative management of pneumobilia following blunt abdominal trauma: a case report and review of the literature.
Article Type: Perspectiva general de la enfermedad/trastorno
Subject: Enfermedades del higado (Investigacion cientifica)
Enfermedades del higado (Analisis de casos)
Enfermedades del higado (Cuidado y tratamiento)
Higado (Investigacion cientifica)
Higado (Analisis de casos)
Higado (Cuidado y tratamiento)
Pub Date: 06/01/2009
Publication: Name: Puerto Rico Health Sciences Journal Publisher: Universidad de Puerto Rico, Recinto de Ciencias Medicas Language: Spanish Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Universidad de Puerto Rico, Recinto de Ciencias Medicas ISSN: 0738-0658
Issue: Date: June, 2009 Source Volume: 28 Source Issue: 2
Geographic: Geographic Name: Puerto Rico
Accession Number: 201212355
Full Text: 6 Non-Operative Management of Pneumobilia following Blunt Abdominal Trauma: A Case Report and Review of the Literature. Jorge J. Zequeira MD, Pablo Rodriguez-Ortiz MD, FACS, FCCM, FACP; Division of Trauma, Department of Surgery, University of Puerto Rico, Medial Sciences Campus, San Juan, Puerto Rico

Introduction: Pneumobilia is an uncommon finding in imaging studies that denotes the presence of air in the biliary tree. It has a myriad of clinical connotations depending on the setting in which it is found. Taking into consideration that only five cases of pneumobilia following blunt abdominal trauma have been reported, we will add an additional case which was managed non-operatively. Method: A literature review was performed using MEDLINE and keywords related to pneumobilia in a trauma setting. The references included in each of the search articles were also reviewed. We will report the case of a seventy-one year old male patient who sustained a motor vehicle accident as a restrained driver. The patient complained of severe pain in his left thigh and mild abdominal discomfort. On physical exam he was hemodynamically stable, had an obvious deformity in his left thigh, associated upper abdominal tenderness without peritoneal signs, and a decreased Glasgow Coma Scale of 14/15. All lab values were within normal limits with the exception of a mild anemia of Hgb 11.3. Imaging studies demonstrated evidence of a cephalohematoma, pneumobilia, duodenal contusions, minimal free fluid on Morrison's pouch, and a left femoral shaft fracture. The patient was admitted, placed on bowel rest, nasogastric suction, and followed with serial physical exams. An abdominal CT scan with intravenous and oral contrast was repeated one day later revealing no new findings. The closed femur fracture was repaired four days after the injury and the nasogastric tube was removed when it drained less than 100ml/24hr. The patient was started on oral feedings and progressed as tolerated. Once he tolerated a regular enteral nutrition, the patient was discharged home and followed at clinics one month later. During ambulatory follow-up, he denied any abdominal pain and stated that he was tolerating the diet and evacuating properly. Results: Pneumobilia has been historically associated to diseases that mandate a surgical intervention. Five cases of pneumobilia after a blunt traumatic injury have been reported in the literature. Two of these patients were managed operatively while the other three were managed expectantly. None of the patients who were explored had findings suggestive of a surgically correctable cause of pneumobilia. Those who were managed expectantly were discharged home without abdominal complications. The proposed mechanism for this event to occur is retrograde flow of air from the duodenum into the biliary system as a consequence of sudden application of extrinsic pressure to the abdomen. Conclusion: Taking into consideration the lack of surgical findings in those patients whose abdomen has been explored we preliminarily propose that patients with radiographic evidence of pneumobilia and no other clinical or radiographic indications for laparotomy should be managed expectantly with bowel rest, nasogastric suction, and serial physical examinations. However, we still believe that pneumobilia is a rare finding after blunt abdominal trauma and more evidence is needed in order to generalize a management strategy for these patients.
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.