Imaging and Intervention of Biliary Leaks and Bilomas

Abstract

Biliary leaks and bilomas develop due to hepatobiliary surgery, trauma, or locoregional therapy for hepatic malignancies. Though uncommon, they can be a source of abdominal pain, hyperbilirubinemia, and sepsis. A variety of diagnostic tools and interventional techniques are available to diagnose and manage biliary leaks and bilomas. Successful management often requires a multidisciplinary approach between the radiologist, surgeon, and endoscopist.

Keywords

biliary leak - biloma - percutaneous drainage - cholecystectomy - thermal ablation - transarterial chemoembolization - radioembolization

• References

• 1 Cervantes J, Rojas GA, Ponte R. Intrahepatic subcapsular biloma. A rare complication of laparoscopic cholecystectomy. Surg Endosc 1994; 8 (3) 208-210
• 2 Gould L, Patel A. Ultrasound detection of extrahepatic encapsulated bile: “biloma”. AJR Am J Roentgenol 1979; 132 (6) 1014-1015
• 3 Copelan A, Bahoura L, Tardy F, Kirsch M, Sokhandon F, Kapoor B. Etiology, diagnosis, and management of bilomas: a current update. Tech Vasc Interv Radiol 2015; 18 (4) 236-243
• 4 Braithwaite BM, Cabanilla LT, Lilly M. Hepatic subcapsular biloma: a rare complication of laparoscopic cholecystectomy and common bile duct exploration. Curr Surg 2003; 60 (2) 196-198
• 5 Chang IS, Rhim H, Kim SH , et al. Biloma formation after radiofrequency ablation of hepatocellular carcinoma: incidence, imaging features, and clinical significance. AJR Am J Roentgenol 2010; 195 (5) 1131-1136
• 6 Safdar N, Said A, Lucey MR , et al. Infected bilomas in liver transplant recipients: clinical features, optimal management, and risk factors for mortality. Clin Infect Dis 2004; 39 (4) 517-525
• 7 Hoffer FA, Teele RL, Lillehei CW, Vacanti JP. Infected bilomas and hepatic artery thrombosis in infant recipients of liver transplants. Interventional radiology and medical therapy as an alternative to retransplantation. Radiology 1988; 169 (2) 435-438
• 8 Dimick JB, Wainess RM, Cowan JA, Upchurch Jr GR, Knol JA, Colletti LM. National trends in the use and outcomes of hepatic resection. J Am Coll Surg 2004; 199 (1) 31-38
• 9 Capussotti L, Ferrero A, Viganò L, Sgotto E, Muratore A, Polastri R. Bile leakage and liver resection: where is the risk?. Arch Surg 2006; 141 (7) 690-694 , discussion 695
• 10 Viganò L, Ferrero A, Sgotto E, Tesoriere RL, Calgaro M, Capussotti L. Bile leak after hepatectomy: predictive factors of spontaneous healing. Am J Surg 2008; 196 (2) 195-200
• 11 Antonopoulos C, Voulimeneas I, Ioannides P, Kotsifas T, Kavallieratos N, Vagianos C. Bile leaks after cholecystectomy: the significance of patient selection. Surg Laparosc Endosc Percutan Tech 2009; 19 (5) 379-383
• 12 Ametani F, Itoh K, Shibata T, Maetani Y, Tanaka K, Konishi J. Spectrum of CT findings in pediatric patients after partial liver transplantation. Radiographics 2001; 21 (1) 53-63
• 13 Barabino M, Gatti A, Santambrogio R , et al. Biliary fistula after liver resection: central role of intraoperative perihepatic drain. Minerva Chir 2016; 71 (6) 353-359
• 14 Tanaka S, Hirohashi K, Tanaka H , et al. Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg 2002; 195 (4) 484-489
• 15 Imamura H, Seyama Y, Kokudo N , et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003; 138 (11) 1198-1206 , discussion 1206
• 16 Clarke DL, Currie EJ, Madhavan KK, Parks RW, Garden OJ. Hepatic resection for benign non-cystic liver lesions. HPB (Oxford) 2004; 6 (2) 115-119
• 17 Erdogan D, Busch OR, Gouma DJ, van Gulik TM. Morbidity and mortality after liver resection for benign and malignant hepatobiliary lesions. Liver Int 2009; 29 (2) 175-180
• 18 Geller DA, Tsung A, Maheshwari V, Rutstein LA, Fung JJ, Marsh JW. Hepatic resection in 170 patients using saline-cooled radiofrequency coagulation. HPB (Oxford) 2005; 7 (3) 208-213
• 19 Delis S, Bakoyiannis A, Tassopoulos N , et al. Clamp-crush technique vs. radiofrequency-assisted liver resection for primary and metastatic liver neoplasms. HPB (Oxford) 2009; 11 (4) 339-344
• 20 Saiura A, Yamamoto J, Koga R, Seki M, Yamaguchi T. Liver transection using the LigaSure sealing system. HPB (Oxford) 2008; 10 (4) 239-243
• 21 Castaldo ET, Earl TM, Chari RS , et al. A clinical comparative analysis of crush/clamp, stapler, and dissecting sealer hepatic transection methods. HPB (Oxford) 2008; 10 (5) 321-326
• 22 Yamashita Y, Hamatsu T, Rikimaru T , et al. Bile leakage after hepatic resection. Ann Surg 2001; 233 (1) 45-50
• 23 Lo CM, Fan ST, Liu CL, Lai EC, Wong J. Biliary complications after hepatic resection: risk factors, management, and outcome. Arch Surg 1998; 133 (2) 156-161
• 24 Jarnagin WR, Gonen M, Fong Y , et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002; 236 (4) 397-406 , discussion 406–407
• 25 Lee JG, Choi SB, Kim KS, Choi JS, Lee WJ, Kim BR. Central bisectionectomy for centrally located hepatocellular carcinoma. Br J Surg 2008; 95 (8) 990-995
• 26 McMahon AJ, Russell IT, Baxter JN , et al. Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial. Lancet 1994; 343 (8890): 135-138
• 27 McMahon AJ, Russell IT, Ramsay G , et al. Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function. Surgery 1994; 115 (5) 533-539
• 28 Gouma DJ, Rauws EA, Keulemans YC, Bergman JJ, Huibregtse K, Obertop H. [Bile duct injuries after a laparoscopic cholecystectomy] [in Dutch]. Ned Tijdschr Geneeskd 1999; 143 (12) 606-611
• 29 Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993; 165 (1) 9-14
• 30 Deziel DJ. Complications of cholecystectomy. Incidence, clinical manifestations, and diagnosis. Surg Clin North Am 1994; 74 (4) 809-823
• 31 Nagano Y, Togo S, Tanaka K , et al. Risk factors and management of bile leakage after hepatic resection. World J Surg 2003; 27 (6) 695-698
• 32 Neumann H, Fry LC, Malfertheiner P, Mönkemüller K. Bile leak from the duct of Luschka. Z Gastroenterol 2010; 48 (2) 256-257
• 33 Stathopoulos V, Georganas M, Stratakis K, Delaporta E, Karallas E, Koutsopoulos K. Hepatic subcapsular biloma: a rare complication of laparoscopic cholecystectomy. Case Rep Surg 2014; 2014: 186819
• 34 Choi KM, Jang HJ, Kwak JH, Kim JH, Ahn JH. Management of postoperative bilomas and biliary injuries associated with laparoscopic cholecystectomy with intrabiliary ethanol ablation and micro-coil embolization. Hepatogastroenterology 2014; 61 (129) 27-30
• 35 Pinkas H, Brady PG. Biliary leaks after laparoscopic cholecystectomy: time to stent or time to drain. Hepatobiliary Pancreat Dis Int 2008; 7 (6) 628-632
• 36 Rossi M, Salvatori FM, Giglio L , et al. Interventional radiology techniques in the treatment of complications due to videolaparoscopic cholecystectomy. Radiol Med (Torino) 2002; 103 (4) 384-395
• 37 Thompson CM, Saad NE, Quazi RR, Darcy MD, Picus DD, Menias CO. Management of iatrogenic bile duct injuries: role of the interventional radiologist. Radiographics 2013; 33 (1) 117-134
• 38 Shin S, Klevan A, Fernandez CA, Astudillo JA, Martinez J. Rendezvous technique for the treatment of complete common bile duct transection after multiple hepatobiliary surgeries. J Laparoendosc Adv Surg Tech A 2014; 24 (10) 728-730
• 39 Lo Nigro C, Geraci G, Sciuto A, Li Volsi F, Sciume C, Modica G. Bile leaks after videolaparoscopic cholecystectomy: duct of Luschka. Endoscopic treatment in a single centre and brief literature review on current management. Ann Ital Chir 2012; 83 (4) 303-312
• 40 Kyokane T, Nagino M, Oda K, Nimura Y. An experimental study of selective intrahepatic biliary ablation with ethanol. J Surg Res 2001; 96 (2) 188-196
• 41 Kyokane T, Nagino M, Sano T, Nimura Y. Ethanol ablation for segmental bile duct leakage after hepatobiliary resection. Surgery 2002; 131 (1) 111-113
• 42 Hai S, Tanaka H, Takemura S, Sakabe K, Ichikawa T, Kubo S. Portal vein embolization for an intractable bile leakage after hepatectomy. Clin J Gastroenterol 2012; 5 (4) 287-291
• 43 Yamakado K, Nakatsuka A, Iwata M , et al. Refractory biliary leak from intrahepatic biliary-enteric anastomosis treated by selective portal vein embolization. J Vasc Interv Radiol 2002; 13 (12) 1279-1281
• 44 Albishri SH, Issa S, Kneteman NM, Shapiro AM. Bile leak from duct of Luschka after liver transplantation. Transplantation 2001; 72 (2) 338-340
• 45 Zhu KS, Meng XC, Huang MS , et al. [The role of early hepatic artery ischemia on biliary complications after liver transplantation and hepatic arterial interventional therapy] [in Chinese]. Zhonghua Yi Xue Za Zhi 2009; 89 (31) 2195-2198
• 46 Chan SC, Fan ST, Lo CM, Liu CL, Wong J. Toward current standards of donor right hepatectomy for adult-to-adult live donor liver transplantation through the experience of 200 cases. Ann Surg 2007; 245 (1) 110-117
• 47 Chan SC, Fan ST, Lo CM , et al. A decade of right liver adult-to-adult living donor liver transplantation: the recipient mid-term outcomes. Ann Surg 2008; 248 (3) 411-419
• 48 Liu CL, Fan ST, Lo CM , et al. Operative outcomes of adult-to-adult right lobe live donor liver transplantation: a comparative study with cadaveric whole-graft liver transplantation in a single center. Ann Surg 2006; 243 (3) 404-410
• 49 Ghobrial RM, Freise CE, Trotter JF , et al; A2ALL Study Group Donor morbidity after living donation for liver transplantation. Gastroenterology 2008; 135 (2) 468-476
• 50 Sakamoto I, Iwanaga S, Nagaoki K , et al. Intrahepatic biloma formation (bile duct necrosis) after transcatheter arterial chemoembolization. AJR Am J Roentgenol 2003; 181 (1) 79-87
• 51 Zhaolin Z, Xuelian L, Wensou H , et al. [Clinical features and risk factors of biloma formation after transcatheter arterial chemoembolization] [in Chinese]. Zhonghua Yi Xue Za Zhi 2015; 95 (13) 1002-1005
• 52 Miyayama S, Yamashiro M, Okuda M , et al. Main bile duct stricture occurring after transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2010; 33 (6) 1168-1179
• 53 Wang Z, Wang M, Duan F, Song P, Liu F. Bile duct injury after transcatheter arterial chemoembolization: risk factors and clinical implications. Hepatogastroenterology 2014; 61 (132) 947-953
• 54 Tu J, Jia Z, Ying X , et al. The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma. Medicine (Baltimore) 2016; 95 (49) e5606
• 55 Dhamija E, Paul SB, Gamanagatti SR, Acharya SK. Biliary complications of arterial chemoembolization of hepatocellular carcinoma. Diagn Interv Imaging 2015; 96 (11) 1169-1175
• 56 Atassi B, Bangash AK, Lewandowski RJ , et al. Biliary sequelae following radioembolization with yttrium-90 microspheres. J Vasc Interv Radiol 2008; 19 (5) 691-697
• 57 Minocha J, Lewandowski RJ. Radioembolization for hepatocellular carcinoma complicated by biliary stricture. Semin Intervent Radiol 2011; 28 (2) 226-229
• 58 Kozar RA, Moore JB, Niles SE , et al. Complications of nonoperative management of high-grade blunt hepatic injuries. J Trauma 2005; 59 (5) 1066-1071
• 59 Bala M, Gazalla SA, Faroja M , 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
• 60 Chen X, Talner LB, Jurkovich GJ. Gallbladder avulsion due to blunt trauma. AJR Am J Roentgenol 2001; 177 (4) 822
• 61 Gander R, Molino JA, Santiago S , et al. [Conservative management of liver trauma and its complications: current gold-standard] [in Spanish]. Cir Pediatr 2016; 29 (1) 19-24
• 62 Al-Hassani A, Jabbour G, El-Labib M, Kanbar A, El-Menyar A, Al-Thani H. Delayed bile leak in a patient with grade IV blunt liver trauma: a case report and review of the literature. Int J Surg Case Rep 2015; 14: 156-159
• 63 Howard R, Bansal S, Munshi IA. Biloma: a delayed complication of blunt hepatic injury. J Emerg Med 2008; 34 (1) 33-35
• 64 Fleming KW, Lucey BC, Soto JA, Oates ME. Posttraumatic bile leaks: role of diagnostic imaging and impact on patient outcome. Emerg Radiol 2006; 12 (3) 103-107
• 65 Wahl WL, Brandt MM, Hemmila MR, Arbabi S. Diagnosis and management of bile leaks after blunt liver injury. Surgery 2005; 138 (4) 742-747 , discussion 747–748
• 66 Wittenberg A, Minotti AJ. CT diagnosis of traumatic gallbladder injury. AJR Am J Roentgenol 2005; 185 (6) 1573-1574
• 67 Brennan PM, Welsh FK, Lyness C, Bathgate AJ, Wigmore SJ. Avulsion of the gallbladder following trivial injury. Int J Clin Pract 2004; 58 (3) 318-321
• 68 Ameh EA, Mai A, Adams LM, Dogo PM, Esangbedo AE, Nmadu PT. Blunt traumatic injury of the gallbladder in childhood. Cent Afr J Med 1997; 43 (9) 272-273
• 69 Losanoff JE, Kjossev KT. Complete traumatic avulsion of the gallbladder. Injury 1999; 30 (5) 365-368
• 70 Feliciano DV. Biliary injuries as a result of blunt and penetrating trauma. Surg Clin North Am 1994; 74 (4) 897-907 , discussion 909–912
• 71 Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics 2004; 24 (5) 1381-1395
• 72 Kim SH, Lim HK, Choi D , et al. Changes in bile ducts after radiofrequency ablation of hepatocellular carcinoma: frequency and clinical significance. AJR Am J Roentgenol 2004; 183 (6) 1611-1617
• 73 Song I, Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol 2009; 19 (11) 2630-2640
• 74 Chiou YY, Hwang JI, Chou YH, Wang HK, Chiang JH, Chang CY. Percutaneous ultrasound-guided radiofrequency ablation of intrahepatic cholangiocarcinoma. Kaohsiung J Med Sci 2005; 21 (7) 304-309
• 75 Akahane M, Koga H, Kato N , et al. Complications of percutaneous radiofrequency ablation for hepato-cellular carcinoma: imaging spectrum and management. Radiographics 2005; 25 (Suppl. 01) S57-S68
• 76 Shankar S, van Sonnenberg E, Silverman SG, Tuncali K, Morrison PR. Diagnosis and treatment of intrahepatic biloma complicating radiofrequency ablation of hepatic metastases. AJR Am J Roentgenol 2003; 181 (2) 475-477
• 77 Ogul H, Kantarci M, Pirimoglu B , et al. The efficiency of Gd-EOB-DTPA-enhanced magnetic resonance cholangiography in living donor liver transplantation: a preliminary study. Clin Transplant 2014; 28 (3) 354-360
• 78 Kantarcı M, Pirimoglu B, Karabulut N , et al. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography. Eur Radiol 2013; 23 (10) 2713-2722
• 79 Pecchi A, DeSantis M, DiBenedetto FK, Gibertini M. Role of magnetic resonance cholangiography in biliary complications of orthotopic liver transplantation. Radiol Med 2010; 115 (7) 1065-1079
• 80 Shigemura T, Yamamoto F, Shilpakar SK, Kojima T, Yamamoto S, Pu Y. MRI differential diagnosis of intrahepatic biloma from subacute hematoma. Abdom Imaging 1995; 20 (3) 211-213
• 81 Boraschi P, Donati F, Rossi M, Ghinolfi D, Filipponi F, Falaschi F. Role of MDCT in the detection of early abdominal complications after orthotopic liver transplantation. Clin Imaging 2016; 40 (6) 1200-1206
• 82 Patel NB, Oto A, Thomas S. Multidetector CT of emergent biliary pathologic conditions. Radiographics 2013; 33 (7) 1867-1888
• 83 Bismpa K, Zlika S, Fouzas I, Imvrios G, Papanikolaou V, Petridis A. Imaging of complications of liver transplantation: multidetector computed tomography findings. Transplant Proc 2012; 44 (9) 2751-2753
• 84 Nikpour AM, Knebel RJ, Cheng D. Diagnosis and management of postoperative biliary leaks. Semin Intervent Radiol 2016; 33 (4) 307-312
• 85 Tsai MJ, Chen JD, Tiu CM, Chou YH, Hu SC, Chang CY. Can acute cholecystitis with gallbladder perforation be detected preoperatively by computed tomography in ED? Correlation with clinical data and computed tomography features. Am J Emerg Med 2009; 27 (5) 574-581
• 86 Yoon W, Jeong YY, Kim JK , et al. CT in blunt liver trauma. Radiographics 2005; 25 (1) 87-104
• 87 Franklin GA, Richardson JD, Brown AL , et al. Prevention of bile peritonitis by laparoscopic evacuation and lavage after nonoperative treatment of liver injuries. Am Surg 2007; 73 (6) 611-616 , discussion 616–617
• 88 Meng XC, Huang WS, Xie PY , et al. Role of multi-detector computed tomography for biliary complications after liver transplantation. World J Gastroenterol 2014; 20 (33) 11856-11864
• 89 Singh AK, Nachiappan AC, Verma HA , et al. Postoperative imaging in liver transplantation: what radiologists should know. Radiographics 2010; 30 (2) 339-351
• 90 Nuñez Jr D, Becerra JL, Martin LC. Subhepatic collections complicating laparoscopic cholecystectomy: percutaneous management. Abdom Imaging 1994; 19 (3) 248-250
• 91 Sammak BM, Yousef BA, Gali MH, al Karawi MA, Mohamed AE. Case report: radiological and endoscopic management of bile leak following laparoscopic cholecystectomy. J Gastroenterol Hepatol 1997; 12 (1) 34-38
• 92 Oliva VL, Nicolet V, Soulez G , et al. Bilomas developing after laparoscopic biliary surgery: percutaneous management with embolization of biliary leaks. J Vasc Interv Radiol 1997; 8 (3) 469-473
• 93 Stampfl U, Hackert T, Radeleff B , et al. Percutaneous management of postoperative bile leaks after upper gastrointestinal surgery. Cardiovasc Intervent Radiol 2011; 34 (4) 808-815
• 94 Saad N, Darcy M. Iatrogenic bile duct injury during laparoscopic cholecystectomy. Tech Vasc Interv Radiol 2008; 11 (2) 102-110
• 95 Covey AM, Brown KT. Percutaneous transhepatic biliary drainage. Tech Vasc Interv Radiol 2008; 11 (1) 14-20