Successful Endoscopic Therapy of Traumatic Bile Leaks

Abstract

Traumatic bile leaks often result in high morbidity and prolonged hospital stay that requires multimodality management. Data on endoscopic management of traumatic bile leaks are scarce. Our study objective was to evaluate the efficacy of the endoscopic management of a traumatic bile leak. We performed a retrospective case review of patients who were referred for endoscopic retrograde cholangiopancreatography (ERCP) after traumatic bile duct injury secondary to blunt (motor vehicle accident) or penetrating (gunshot) trauma for management of bile leaks at our tertiary academic referral center. Fourteen patients underwent ERCP for the management of a traumatic bile leak over a 5-year period. The etiology included blunt trauma from motor vehicle accident in 8 patients, motorcycle accident in 3 patients and penetrating injury from a gunshot wound in 3 patients. Liver injuries were grade III in 1 patient, grade IV in 10 patients, and grade V in 3 patients. All patients were treated by biliary stent placement, and the outcome was successful in 14 of 14 cases (100%). The mean duration of follow-up was 85.6 days (range 54-175 days). There were no ERCP-related complications. In our case review, endoscopic management with endobiliary stent placement was found to be successful and resulted in resolution of the bile leak in all 14 patients. Based on our study results, ERCP should be considered as first-line therapy in the management of traumatic bile leaks.

Endoscopic treatment of biliary leak following gunshot injury: A case report

“…Endoscopic biliary treatment with stenting has been reported to be safe and effective for persistent bile leakage and may eliminate the need for difficult operations in high-risk postoperative cases. [810] In our patient, endoscopic sphincterotomy with stent insertion across the major papilla of Vater to the right intrahepatic duct close to the point of the leak resulted in relieving the pressure gradient between the bile ducts and duodenum. The physiological background of performing endoscopic sphincterotomy and common bile duct (CBD) stenting is to allow the reduction of the pressure gradient between the bile duct and the duodenum by passing the sphincter of Oddi.…”

“…[7] In a recent case report series of 14 traumatic biliary injuries over a period of 5 years treated at University of Texas Health Science Center, Houston, Texas, USA, only 3 cases were due to gunshot injuries. [8]…”

“…Traumatic biliary injuries often result in high morbidity and prolonged hospital stay, and may result in intrahepatic biloma, intraperitoneal leakage of bile, hemobilia and intra-abdominal abscess. [78] Management of these cases often requires a surgeon experienced in biliary reconstruction. [7] In the present case, the patient underwent laparotomy, following which a surgical drain was inserted.…”

BioGlue for traumatic liver laceration

“…By adding BioGlue following ERCP with stenting, her post operative course was expedited. In one case series, ERCP with stenting alone showed resolution of biliary leak and discharge from the hospital on an average of 8.5 days post intervention [11] . In the presented case the addition of BioGlue allowed for resolution of the leak and discharge from the hospital on day six.…”

Management of Traumatic Bile Leakage

“…Whether or not the location of the bile leak can predict treatment outcome is still unclear and cannot be elicited from M P Spinn's data [9]. But I think injury location is another significant factor for major bile leak.…”