Major Intrahepatic Bile Duct Injuries Detected after Laparotomy: Selective Nonoperative Management

Abstract

Nonoperative techniques can be used to successfully manage selected patients and represent a reasonable alternative to operative intervention and resectional therapy, especially in the compromised patient. Extended length of stay is to be expected, but good outcomes can be achieved.

Postoperative management of noniatrogenic traumatic bile duct injuries: role of endoscopic retrograde cholangiopancreaticography

“…Initial reports in the surgical literature highlighted the role of ERCP only in the diagnosis of bile duct leaks [4,11]. Subsequent case reports of adult and pediatric patients showed that in selected cases, ERCP with biliary stenting could help in resolving bile leaks [3,7,9].…”

“…Subsequent case reports of adult and pediatric patients showed that in selected cases, ERCP with biliary stenting could help in resolving bile leaks [3,7,9]. DÕAmours et al [4] presented five patients with major bile duct injuries. Three of these patients were treated with sphincterotomy and stenting, whereas two underwent ERCP-assisted nasobiliary drain placement.…”

“…Treatment also depends on associated organ injuries and local expertise [4,12]. The outcomes of endoscopic retrograde cholangiopancreaticography (ERCP) therapy for these patients are not well defined.…”

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

“…There are several case series in the adult literature as well as in the pediatric literature describing the non-operative treatment of intrahepatic bile duct injuries and bilomas, including percutaneous radiologic drainage and stenting as well as therapeutic ERCP [13]. This case demonstrates that treatment of recognized intrahepatic bile duct injury and its complications through percutaneous drainage and rendering the ductal sphincter incompetent can promote healing.…”

Hepatic Trauma

“…Primary repair of the injured duct is unlikely to be successful and is rarely attempted. ERC should be relied on for both diagnosis and treatment [42] (Figure 20). Occasionally, the ductal injury can be stented, but sphincterotomy with placement of a common bile duct stent effectively reduces pressure within the biliary system and promotes healing [40,43].…”