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

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

“…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.…”

“…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.…”

“…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.…”

“…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.…”

“…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.…”