Risk factors and management of different types of biliary injuries in blunt abdominal trauma: Single-center retrospective cohort study

Zakaria, Hazem; Oteem, Ahmed; Gaballa, Nahla K.; Hegazy, Osama; Nada, Ali; Zakareya, Talaat; Omar, Hazem; Abdelkawy, Hazem; Abdeldayem, Hesham; Gad, Emad Hamdy

doi:10.1016/j.amsu.2020.02.009

Cited by 6 publications

(16 citation statements)

References 23 publications

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“…3 Bile leaks occur in 6 to 20% of patients, with variable time until presentation, 4 at a reported mean time of 5 days. 5 These are often complications after hepatic arterial interventions, especially in high-grade liver injury, related to biliary ischemia. 6 Patients undergoing posttrau-matic cholecystectomy with cystic duct injury are also at high risk.…”

Section: Posttraumatic Liver Complications Bile Leak and Bilomamentioning

confidence: 99%

“…2,10 Delayed recognition and treatment of biliary leaks can lead to the development of a biloma, occurring in 2 to 12% of patients with hepatic trauma. 1,5 Peripheral bile duct leaks are less clinically significant, with central leaks being a more common cause of biloma development and bile peritonitis. 2 Early treatment of a biloma is essential to prevent infection and sepsis.…”

Section: Posttraumatic Liver Complications Bile Leak and Bilomamentioning

confidence: 99%

“…2 Early treatment of a biloma is essential to prevent infection and sepsis. 5 Biliary cutaneous fistulas can develop, 11 and the collection of bile may cause an inflammatory response, delaying hepatic healing and causing vascular abnormalities such as pseudoaneurysms. 1 Smaller bilomas (<3 cm) may resolve with conservative treatment.…”

Section: Posttraumatic Liver Complications Bile Leak and Bilomamentioning

confidence: 99%

“…1,12 Addressing the underlying biliary leak with percutaneous drainage is effective in 70 to 100% of larger collections. 2,5,8 Persistent leaks or expanding bilomas may require endoscopic retrograde cholangiopancreatography (ERCP) with stenting or 2,5,10 embolization of the cystic duct using coils via the existing percutaneous tract. 13 In rare cases, ablation of the offending hepatobiliary segment has been described, using absolute alcohol, acetic acid, cyanoacrylate glue, or laser therapy.…”

Section: Posttraumatic Liver Complications Bile Leak and Bilomamentioning

confidence: 99%

“…2 In a stable patient, various endoscopic techniques in management may be utilized, such as epinephrine injection, cautery, or stenting, though definitive treatment often involves visualization of the offending vessels via arteriography, followed by transarterial embolization. 2,5,15,16 Fistulas involving the portal vein in the setting of portal hypertension do occur 17 and can be the result of trauma. 18,19 These often require surgical intervention.…”

Section: Hemobiliamentioning

confidence: 99%

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Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist

Wolf

Smolinski-Zhao

2021

Semin intervent Radiol

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In addition to acute injury requiring interventional radiologic treatments, patients with traumatic injuries can develop delayed or chronic complications. These injuries can involve nearly all solid organs in the abdomen. Coupled with significant improvements in visualizing these injuries with advanced imaging techniques such as minimally invasive procedures, nonoperative management of both acute traumatic injuries and their longer term sequelae has become the norm. This article reviews frequently seen complications of traumatic injury and their management by interventional radiologists.

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Section: Posttraumatic Liver Complications Bile Leak and Bilomamentioning

confidence: 99%

Section: Posttraumatic Liver Complications Bile Leak and Bilomamentioning

confidence: 99%

Section: Posttraumatic Liver Complications Bile Leak and Bilomamentioning

confidence: 99%

Section: Posttraumatic Liver Complications Bile Leak and Bilomamentioning

confidence: 99%

Section: Hemobiliamentioning

confidence: 99%

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Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist

Wolf

Smolinski-Zhao

2021

Semin intervent Radiol

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MultiCenter Study of Intra-Abdominal Abscess Formation After Major Operative Hepatic Trauma

Smith,

Cone,

McNickle

et al. 2024

Journal of Surgical Research

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Diagnosis and management of bile leaks after severe liver injury: A Trauma Association of Canada multicenter study

Schellenberg¹,

Ball²,

Owattanapanich³

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Optimal management of bile leaks (BLs) after severe liver injury is unknown. Study objectives were to define current practices in diagnosis and management of BL to determine which patients may benefit from endoscopic retrograde cholangiopancreatography (ERCP). METHODS:American Association for the Surgery of Trauma grade ≥III liver injuries from 10 North American trauma centers were included in this retrospective study (February 2011 to January 2021). Groups were defined as patients who developed BL versus those who did not. Subgroup analysis of BL patients was performed by management strategy. Bivariate analysis compared demographics, clinical/injury data, and outcomes. Receiver operating characteristic curves were performed to investigate the relationship between bilious drain output and ERCP. RESULTS:A total of 2,225 patients with severe liver injury met the study criteria, with 108 BLs (5%). Bile leak patients had higher American Association for the Surgery of Trauma grade of liver injury ( p < 0.001) and were more likely to have been managed operatively from the outset (69% vs. 25%, p < 0.001). Bile leak was typically diagnosed on hospital day 6 [4-10] via surgical drain output (n = 37 [39%]) and computed tomography scan (n = 34 [36%]). On the BL diagnosis day, drain output was 270 [125-555] mL. Endoscopic retrograde cholangiopancreatography was the most frequent management strategy (n = 59 [55%]), although 32 patients (30%) were managed with external drains alone. Bile leak patients who underwent ERCP, surgery, or percutaneous transhepatic biliary drain had higher drain output than BL patients who were managed with external drains alone (320 [180-720] vs. 138 [85-330] mL, p = 0.010). Receiver operating characteristic curve analysis of BL demonstrated moderate accuracy (area under the receiver operating characteristic curve, 0.636) for ERCP at a cutoff point of 390 mL of bilious output on the day of diagnosis. CONCLUSION:Patients with BL >300 to 400 mL were most likely to undergo ERCP, percutaneous transhepatic biliary drain, or surgical management.Once external drainage of BL has been established, we recommend ERCP be reserved for patients with BL >300 mL of daily output. Prospective multicenter examination will be required to validate these retrospective data.

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Risk factors and management of different types of biliary injuries in blunt abdominal trauma: Single-center retrospective cohort study

Cited by 6 publications

References 23 publications

Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist

Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist

MultiCenter Study of Intra-Abdominal Abscess Formation After Major Operative Hepatic Trauma

Diagnosis and management of bile leaks after severe liver injury: A Trauma Association of Canada multicenter study

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