Biliary leak after severe hepatic trauma is a complex problem requiring multidisciplinary care. We report on our experience with endoscopic management of posttraumatic bile leaks and clarify the role of endoscopic retrograde cholangiopancreatography (ERCP).
A retrospective analysis was performed on all patients who sustained liver injury and underwent ERCP from September 2003 to September 2009. Patients who had associated biliary leak were identified. Patient demographics, injury characteristics, liver operations, endoscopic treatment, and success of endoscopic intervention were reviewed. Liver injury was managed in an interdisciplinary fashion, including immediate or delayed operation or angiography or both for primary or adjunctive hemostasis. ERCP with stenting and sphincterotomy was used to treat biliary fistulae. Sequelae of liver injury including biloma or other perihepatic fluid collection were also managed by computed tomography scan-guided or ultrasound-guided drainage.
A total of 26 patients underwent ERCP for the management of biliary fistula as a result of severe hepatic trauma. There were 14 (54%) blunt injuries. In every patient (100%), ERCP with stenting and sphincterotomy was successful in controlling bile leak. All patients eventually had removal of stents and drains, with resolution of leak. Two patients had concomitant treatment of associated pancreatic ductal injury.
ERCP is useful as both a diagnostic and therapeutic tool for the safe treatment of biliary ductal injuries after severe liver trauma and should be part of a multidisciplinary treatment algorithm.
From the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
Submitted for publication April 7, 2010.
Accepted for publication June 30, 2010.
Address for reprints: Thomas M. Scalea, MD, R Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 South Greene Street, Baltimore, MD 21201-1595; email: email@example.com.