Korean J Pediatr Gastroenterol Nutr.  2010 Sep;13(2):204-209. 10.5223/kjpgn.2010.13.2.204.

A Case of Obstructive Jaundice Secondary to Traumatic Pancreatitis Treated with Percutaneous Transhepatic Biliary Drainage

• Park JS
• Baek JG
• Yeom JS
• Park ES
• Seo JH
• Lim JY
• Park CH
• Woo HO
• Youn HS
• Shin TB

• KMID: 1459437
• DOI: http://doi.org/10.5223/kjpgn.2010.13.2.204

Abstract

Isolated pancreatic trauma and secondary obstructive jaundice in the pediatric population is unusual. Biliary tract obstruction can be a major cause of acute pancreatitis. We report a case of obstructive jaundice secondary to isolated traumatic acute pancreatitis in a previously healthy 32-month-old girl. In our case, secondary obstructive jaundice aggravated the pancreatic inflammation and was successfully treated with percutaneous transhepatic biliary drainage (PTBD).

Keyword

Trauma; Pancreatitis; Obstructive jaundice

MeSH Terms

Biliary Tract
Drainage
Inflammation
Jaundice, Obstructive
Pancreatitis
Preschool Child

Figure

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  Fig. 1 Whole abdominal computed tomography was performed on admission (A, B) showing diffuse pancreatic swelling and peripancreatic fluid collection (arrows), a relatively intact common bile duct (solid arrow), and a part of the gallbladder (dotted arrow), and 10 days after admission (C) showing intra- and extra-hepatic biliary duct dilatation (arrow) and milder pancreatic swelling and a decreased amount of peripancreatic fluid collection than before.

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  Fig. 2 Magnetic resonance cholangiopancreaticography was performed 28 days after admission showing a distended gallbladder, dilated biliary trees, and pancreatic duct (dotted arrow) and low signal lesion suggestive of a biliary stone in the distal common bile duct (solid arrow) and biliary sludge in the gallbladder.

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  Fig. 3 Cholangiograms through the percutaneous transhepatic biliary drainage catheter were performed 33 days after admission (A) showing marked dilated intra- and extra-hepatic bile ducts, and a smooth, tapering biliary stricture in the distal common bile duct (solid arrow), and 35 days after admission (B) showing a mild dilated pancreatic duct and a filling defect (dotted arrow) in the distal common bile duct suggestive of a biliary stone which was removed by a skilled interventional radiologist via a stone basket and shown to be a small amount of biliary sludge, and 66 days after admission (C) showing no biliary dilatation or stricture of the common bile duct with free flow of contrast media from the common bile duct to the second portion of the duodenum.

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  Fig. 4 Serial changes of laboratory findings, (A) serum amylase and lipase, (B) serum total bilirubin and direct bilirubin according to days after admission show temporal relationsship with (A) and (B).

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