Журнал травм и лечения

Bile Leak Following Liver Trauma: Diagnosis and Management from a Trauma Centre with Matched Controls

Abstract

Tara Lintern1 and Nicholas J. Fischer2,3*

Background: Bile leaks are a well recognised complication following liver trauma, however the incidence is rare, and literature is limited. The aims of this study were to identify incidence, risk factors, diagnosis, and management of bile leaks from a large cohort of liver trauma patients.

Methods: All patients with liver trauma over a 15-year period at a trauma centre were retrospectively reviewed using data from a prospective trauma registry. Clinical records, radiology, and laboratory data were reviewed. A comparative analysis compared patients with bile leaks to liver injury grade matched controls.

Results: From this cohort of 473 patients with liver trauma, 31 (6.6%) had a bile leak. High grade injury was a risk factor, occurring in 30% of these patients, as well as parenchymal damage extending into the porta-hepatis. Serum bilirubin levels over 40 μmol/L were predictive of a bile leak. Endoscopic biliary decompression with a transampullary stent was the most common management technique. Surgical management associated with high bile drainage volumes.

Conclusion: Bile leak as sequelae of liver trauma occurs in high grade injuries. Serum bilirubin levels over 40 μmol/L are predictive of bile leak. Most cases are managed with endoscopic decompression; however, high volume drainage is associated with definitive surgical management.