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<article xml:lang="KO" article-type="case-report">

<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">J Korean Assoc Pediatr Surg</journal-id>
<journal-id journal-id-type="publisher-id">JKAPS</journal-id>
<journal-title-group>
<journal-title>Journal of the Korean Association of Pediatric Surgeons</journal-title>
</journal-title-group>
<issn pub-type="ppub">2383-5036</issn>
<issn pub-type="epub">2383-5508</issn>
<publisher>
<publisher-name>Korean Association of Pediatric Surgeons</publisher-name>
</publisher>
</journal-meta>

<article-meta>
<article-id pub-id-type="doi">10.13029/jkaps.2018.24.1.30</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Bile Duct Stricture and Intrahepatic Cystic Formation after Abdominal Injury due to Child Abuse: A Case Report</article-title>
</title-group>

<contrib-group>

<contrib contrib-type="author">
<name>
<surname>Ihn</surname>
<given-names>Kyong</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Koo</surname>
<given-names>Eun-Jung</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Ho</surname>
<given-names>In Geol</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Lee</surname>
<given-names>Dongeun</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>

<contrib contrib-type="author" corresp="yes">
<contrib-id contrib-id-type="orcid" authenticated="true">https://orcid.org/0000-0001-5224-1437</contrib-id>
<name>
<surname>Han</surname>
<given-names>Seok Joo</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>

</contrib-group>

<aff id="A1"><label>1</label>Department of Surgery, Yonsei University College of Medicine, Seoul, <country>Korea</country>.</aff>
<aff id="A2"><label>2</label>Department of Pediatric Surgery, Severance Children's Hospital, Seoul, <country>Korea</country>.</aff>
<aff id="A3"><label>3</label>Department of Pediatric Surgery, Keimyung University Dongsan Medical Center, Daegu, <country>Korea</country>.</aff>

<author-notes>
<corresp>Correspondence: Seok Joo Han, Department of Pediatric Surgery, Severance Children's Hospital, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-2130, Fax: +82-2-313-8289, <email>sjhan@yuhs.ac</email></corresp>
</author-notes>

<pub-date pub-type="ppub">
<month>06</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>06</month>
<year>2018</year>
</pub-date>
<volume>24</volume>
<issue>1</issue>
<fpage>30</fpage>
<lpage>34</lpage>

<history>
<date date-type="received">
<day>15</day>
<month>04</month>
<year>2018</year>
</date>
<date date-type="accepted">
<day>15</day>
<month>05</month>
<year>2018</year>
</date>
</history>

<permissions>
<copyright-statement>Copyright &#x00A9; 2018 Korean Association of Pediatric Surgeons</copyright-statement>
<copyright-year>2018</copyright-year>
<copyright-holder>Korean Association of Pediatric Surgeons</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0">
<license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://creativecommons.org/licenses/by-nc/4.0">http://creativecommons.org/licenses/by-nc/4.0</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>

<abstract>
<p>A 6-year-old male who lived with a mother in a single-parent family was referred to the emergency room with multiple traumas. There was no specific finding on CT scan of the other hospital performed 55 days before admission. However, CT scan at the time of admission showed common bile duct (CBD) stenosis, proximal biliary dilatation and bile lake formation at the segment II and III. Endoscopic retrograde biliary drainage was performed, but the tube had slipped off spontaneously 36 days later, and follow-up CT scan showed aggravated proximal biliary dilatation above the stricture site. He underwent excision of the CBD including the stricture site, and the bile duct was reconstructed with Roux-en-Y hepaticojejunostomy. Pathologic report of the resected specimen revealed that the evidence of trauma as a cause of bile duct stricture. While non-iatrogenic extrahepatic biliary trauma is uncommon, a level of suspicion is necessary to identify injuries to the extrahepatic bile duct. The role of the physicians who treat the abused children should encompass being suspicious for potential abdominal injury as well as identifying visible injuries.</p>
</abstract>

<kwd-group>
<kwd>Child abuse</kwd>
<kwd>Bile duct</kwd>
<kwd>Multiple trauma</kwd>
<kwd>Blunt injury</kwd>
</kwd-group>

</article-meta>
</front>

<back>

<fn-group>
<fn fn-type="conflict">
<label>CONFLICTS OF INTEREST</label>
<p>No potential conflict of interest relevant to this article was reported.</p>
</fn>
</fn-group>

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<floats-group>

<fig position="float" id="F1">
<label>Fig. 1</label>
<caption>
<title>Contrast-enhanced abdominal CT scan. (A) CT scan taken two months before admission shows no visible bile duct dilatation or bile lake in the upper abdomen. (B) CT scan taken at the admission shows stenosis at proximal common bile duct with common hepatic duct dilatation and a bile lake at S2/3 of the liver.</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkaps-24-30-g001"></graphic>
</fig>

<fig position="float" id="F2">
<label>Fig. 2</label>
<caption>
<title>Timeline plot of clinical course. CBD, common bile duct; ERBD, endoscopic retrograde biliary drainage.</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkaps-24-30-g002"></graphic>
</fig>

<fig position="float" id="F3">
<label>Fig. 3</label>
<caption>
<title>The changes and trends of each liver function tests. TB, total bilirubin; GGT, gamma-glutamyl transpeptidase; ERBD, endoscopic retrograde biliary drainage.</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkaps-24-30-g003"></graphic>
</fig>

<fig position="float" id="F4">
<label>Fig. 4</label>
<caption>
<title>(A) CT scan taken at the 2nd admission shows the distal migration of endoscopic retrograde biliary drainage catheter with aggravated proximal biliary dilatation above the stricture site of mid-common bile duct. (B) Cholangiography during the operation.</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkaps-24-30-g004"></graphic>
</fig>

<fig position="float" id="F5">
<label>Fig. 5</label>
<caption>
<title>Linear capsular fibrotic change on the left 3 cm from the falciform ligament (arrows).</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkaps-24-30-g005"></graphic>
</fig>

</floats-group>

</article>