Diagnosis and nonsurgical management of bile leak complicated by biloma after blunt liver injury: report of two cases

Backer, A. De; Fierens, H.; Schepper, A. De; Pelckmans, Paul; Jorens, P. G.; Vaneerdeweg, W.

doi:10.1007/s003300050598

Cited by 42 publications

(24 citation statements)

References 6 publications

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“…In the face of a leak confirmed by HIDA or in a setting of high clinical suspicion, early ERCP is essential as it allows for localization of a leak and has therapeutic value [18,19]. Magnetic resonance cholangiopancreatography (MRCP) can also be helpful to diagnose a biliary tract injury in the event of failed diagnostic ERCP as described by Wong et al [20] in a case of extrahepatic bile duct disruption with hindered visualization by ERCP due to obstruction of the common bile duct.…”

Section: Discussionmentioning

confidence: 99%

Blunt Left Extrahepatic Bile Duct Injury: Case Report and Literature Review

Mestral¹,

Razek²,

Khwaja³

et al. 2008

Eur J Trauma Emerg Surg

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Section: Discussionmentioning

confidence: 99%

Blunt Left Extrahepatic Bile Duct Injury: Case Report and Literature Review

Mestral¹,

Razek²,

Khwaja³

et al. 2008

Eur J Trauma Emerg Surg

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“…In the trauma patient the detection of major intrahepatic duct injury (first-or second-order hepatic duct) is usually delayed, and made subsequent to the development of complications such as bile fistulae, bile ascites, bilomas, abscesses, or hemobilia. There are no studies regarding the evaluation of intrahepatic bile ducts as part of the early assessment of blunt liver trauma [15]. This is in contrast to the evaluation of potential living liver donors, in many centers the biliary tree is routinely assessed for anomalies [6].…”

Section: Discussionmentioning

confidence: 99%

Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor

et al. 2004

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We report the case of an ultimately successful liver transplant recipient whose post-transplant course was complicated by the early development of multiple abscesses in the graft. Post-transplant cholangiography identified multiple shear injuries to the second and third order intrahepatic bile ducts, originating from blunt trauma to the donor liver. Treatment was non-operative following recent reports of the successful management of intrahepatic bile duct injury in the stable trauma patient. This discussion adds to the limited literature available on the transplantation of injured donor livers, despite this being a relatively common practice. Further experience is needed in determining the appropriate criteria for the use of traumatized donor livers. Cholangiography carried out on the back

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“…The drainage should remain in place until the communication between the biliary system and the biloma cannot longer be demonstrated by direct opacification or nuclear imaging technique (Fig. 7) [20,72].…”

Section: Bilomamentioning

confidence: 99%

“…Endoscopic treatments, including sphincterotomy, nasobiliary drainage, or biliary stent insertion, are effective tools for the management of posttraumatic bile leakage (Fig. 7) [68,69,72,73]. A temporary stent, placed to bridge a common bile duct laceration or bypass either right or left main hepatic ducts defect, will induce subsequent healing of the fistula, confirmed by follow-up ERCP and/or radionuclide scan before stent removal [19,68,72,74,75].…”

Section: Biliary Fistulamentioning

confidence: 99%

Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

Goffette

Laterre

2002

Eur Radiol

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The nonoperative management (NOM) of abdominal trauma has gained increasing acceptance over the past decade. This approach has been extended to severe trauma patients previously considered as candidates for surgery. Consequently, the incidence of delayed and uncommonly encountered complications has increased. Causes of delayed complications are multiple and include: (a) abnormal or insufficient injury healing process; (b) retention of necrotic tissue; (c) secondary infection of initially sterile collections; and (d) underestimation of injury severity. The purpose of this review article is to explain the role of various imaging modalities in detecting post-traumatic delayed complications and to highlight the usefulness of minimally invasive techniques, including laparoscopy, biliary endoscopy, therapeutic angiography and image-guided drainage. Subsequent complications, which do not necessarily negatively influence the final outcome, are often predictable, virtually obligatory consequences of the successful NOM of high-grade or complex abdominal injuries. Between 50 and 60% of those patients with grade-IV or grade-V liver or splenic lacerations require some type of interventional treatment; therefore, indiscriminate discharge of patients with solid organ injury managed conservatively may be potentially harmful. As the incidence of complications is higher for more severe grade-IV or grade-V liver, spleen, or kidney injuries, scheduled follow-up CT scans may be rational in this subset of patients to identify potential complications amenable to early application of interventional techniques. Follow-up CT scans are unnecessary in stable adults or children with low-grade injury. Delayed splenic or hepatic rupture is one of the major concerns because this type of complication remains difficult to predict and historically often requires emergent surgery. These ruptures may benefit from NOM, should the same criteria as for primary rupture be respected. Conversely, parenchymatous focal pooling of contrast on initial CT is a good predictor for the development of delayed vascular malformation. In children, as a large part of splenic and hepatic vascular malformations resolve spontaneously, expectant observation may be indicated provided that a strict imaging follow-up is performed until complete disappearance of these lesions. If needed, embolization of parenchymal vascular lesions should be performed as selectively as possible in order to avoid functional parenchyma loss and to reduce the risk of secondary infection of hematoma or ischemic tissue. Technical improvements, such as microcatheter systems and direct percutaneous approach to targeted lesions, have widened the potential for safe endovascular management of acquired vascular malformations. Advantages and disadvantages relative to the different embolic agents are explained. Endoscopic retrograde pancreatography is the chief investigational tool for detecting biliary and pancreatic ducts injuries. The respective roles of endoscopic, percutaneous and surgical approaches...

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Diagnosis and nonsurgical management of bile leak complicated by biloma after blunt liver injury: report of two cases

Cited by 42 publications

References 6 publications

Blunt Left Extrahepatic Bile Duct Injury: Case Report and Literature Review

Blunt Left Extrahepatic Bile Duct Injury: Case Report and Literature Review

Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor

Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

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