Endoscopic sphincterotomy and temporary internal stenting for bile leaks following complex hepatic trauma

Abstract

ERCP, biliary sphincterotomy and temporary internal stenting, together with percutaneous drainage of intra-abdominal or intrahepatic bile collections, represent a safe and effective strategy for the management of bile leaks following both blunt and penetrating hepatic trauma.

Complex Liver Trauma With Bilhemia Treated With Perihepatic Packing and Endovascular Stent in the Vena Cava

“…Successful use of an ERCP and stenting of the papilla in patients with bile leak after liver trauma has been described. 8 In this case, a biliovenous shunt was diagnosed. Because the goal in the management of posttraumatic bilihemia is to decrease the intraluminal pressure in the bile ducts to avoid shunting of bile into the bloodstream, endoscopic therapy of bilhemia using an ERCP endostenting and sphincterotomy is a therapy that can be performed safely for patients with bilhemia.…”

Endoscopic Retrograde Cholangiopancreatography Is an Effective Treatment for Bile Leak After Severe Liver Trauma

“…Previous significantly smaller retrospective reviews have documented the use of ERCP in the treatment of traumatic biliary injury. 7,11,12 There are also scattered case reports documenting the feasibility of this technique. 13,14 The current series is the largest series documenting the use of this modality in the treatment of traumatic biliary fistula in both blunt and penetrating hepatic injuries.…”

“…This may be accomplished by stenting of the bile duct, sphincterotomy, or by a combination of the two. 11,15 Controversy exists over which specific ERCP maneuver should be used. 16 Another approach to the problem, although using the same physiologic principle, is endoscopic placement of a nasobiliary catheter.…”

Management of blunt hepatic trauma

“…Sphincterotomy allows free flow of bile into the duodenum overcoming the resistance of the sphincter of Oddi. Stent placement allows bile duct healing within 10 days while avoiding persistent fistula and cicatricial stricture with 90-100% success [42,43]. However, these methods are ineffective for sequestrum resulting from hepatic fracture, where hepatic vascularization remains intact while the disrupted bile ducts evacuate their content freely into the peritoneal cavity.…”