Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Management of Bile Leaks from Bilateral Intrahepatic Ducts after Blunt Trauma

둔상성 외상 후 양측 간내 담관에서 담즙 누출의 치료 사례 1례

  • Kim, Dong Hun (Trauma Center, Department of Surgery, Dankook University Hospital) ;
  • Choi, Seokho (Trauma Center, Department of Surgery, Dankook University Hospital) ;
  • Go, Seung Je (Department of Surgery, Eulji University Hospital)
  • 김동훈 (단국대학교병원 외과 권역외상센터) ;
  • 최석호 (단국대학교병원 외과 권역외상센터) ;
  • 고승제 (을지대학교병원 외과)
  • Received : 2014.07.22
  • Accepted : 2014.08.21
  • Published : 2014.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.

Keywords

References

  1. David Richardson J, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 2000; 232: 324-30. https://doi.org/10.1097/00000658-200009000-00004
  2. Richardson JD. Changes in the management of injuries to the liver and spleen. J Am Coll Surg 2005; 200: 648-69. https://doi.org/10.1016/j.jamcollsurg.2004.11.005
  3. Cuff RF, Cogbill TH, Lambert PJ. Nonoperative management of blunt liver trauma: the value of follow-up abdominal computed tomography scans. Am Surg 2000; 66: 332-6.
  4. Bala M, Gazalla SA, Faroja M, Bloom AI, Zamir G, Rivkind AI, et al. Complications of high grade liver injuries: management and outcome with focus on bile leaks. Scand J Trauma Resusc Emerg Med 2012; 20: 20. https://doi.org/10.1186/1757-7241-20-20
  5. Carrillo EH, Spain DA, Wohltmann CD, Schmieg RE, Boaz PW, Miller FB, et al. Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries. J Trauma 1999; 46: 619-22; discussion 22-4. https://doi.org/10.1097/00005373-199904000-00010
  6. Wahl WL, Brandt MM, Hemmila MR, Arbabi S. Diagnosis and management of bile leaks after blunt liver injury. Surgery 2005; 138: 742-7; discussion 7-8. https://doi.org/10.1016/j.surg.2005.07.021
  7. Hollands MJ, Little JM. Post-traumatic bile fistulae. J Trauma 1991; 31: 117-20. https://doi.org/10.1097/00005373-199101000-00023
  8. Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 1995; 221: 744-53; discussion 53-5. https://doi.org/10.1097/00000658-199506000-00013
  9. Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 2000; 231: 804-13. https://doi.org/10.1097/00000658-200006000-00004
  10. Sanchez-Bueno F, Fernandez-Carrion J, Torres Salmeron G, Garcia Perez R, Ramirez Romero P, Fuster Quinonero M, et al. Changes in the diagnosis and therapeutic management of hepatic trauma. A retrospective study comparing 2 series of cases in different (1997-1984 vs. 2001-2008). Cir Esp 2011; 89: 439-47. https://doi.org/10.1016/j.ciresp.2011.04.002
  11. Kozar RA, Moore JB, Niles SE, Holcomb JB, Moore EE, Cothren CC, et al. Complications of Nonoperative Management of High-Grade Blunt Hepatic Injuries. The Journal of Trauma: Injury, Infection, and Critical Care 2005: 1066-71.
  12. Choi SM, Chae MK, Kim TY, Kim SY, Baek MJ, Lee MS, et al. Nonoperative management of blunt hepatic trauma. J Trauma Inj 2002; 15: 14-21.
  13. Pachter HL, Knudson MM, Esrig B, Ross S, Hoyt D, Cogbill T, et al. Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma 1996; 40: 31-8. https://doi.org/10.1097/00005373-199601000-00007
  14. Spinn MP, Patel MK, Cotton BA, Lukens FJ. Successful endoscopic therapy of traumatic bile leaks. Gastroenterol 2013; 7: 56-62.
  15. Lubezky N, Konikoff FM, Rosin D, Carmon E, Kluger Y, Ben-Haim M. Endoscopic sphincterotomy and temporary internal stenting for bile leaks following complex hepatic trauma. Br J Surg 2006; 93: 78-81. https://doi.org/10.1002/bjs.5195