Percutaneous Management of Traumatic Biliary Injuries

Moni Stein; Felix D. Battistella

doi:10.1055/s-2003-43318

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2003; 20(2): 141-150
DOI: 10.1055/s-2003-43318

Percutaneous Management of Traumatic Biliary Injuries

Moni Stein¹ , Felix D. Battistella²

¹Radiologist, Great Lakes Radiologists, River Hills, Wisconsin
²Department of Surgery, University of California, Davis Medical Center, Sacramento, California

Abstract

ABSTRACT

Significant biliary injuries associated with abdominal trauma occur infrequently, but they can result in considerable morbidity. To date, there is no classification scheme for biliary injuries. Furthermore, the multidisciplinary approach that characterizes care of hepatic vascular injuries is not nearly as well developed for biliary injuries. This article proposes a new classification scheme for traumatic biliary injuries and describes how a multidisciplinary approach involving surgeons, gastroenterologists, and interventional radiologists can improve the care of these patients. This classification is based on the anatomic location of the injured duct and the location of the bile leak (intra- versus extrahepatic biloma). This classification also has implications on types of treatment that are recommended.

KEYWORDS

Bile duct - biloma - biliary fistula - trauma - liver laceration

Full Text

References

REFERENCES

1 Feliciano D V, Lewis C A. Hepatic trauma. In: Pitt HA, Carr-Lock DL, Ferrucci JT, eds. Hepatobiliary and Pancreatic Disease: The Team Approach to Management New York: Little Brown & Co 1995
2 Croce M A, Fabian T C, Kudsk K A. et al . AAST organ injury scale: correlation of CT-graded liver injuries and operative findings. J Trauma . 1991; 31 806-812
3 Buechter K J, Zeppa R, Gomez G. The use of segmental anatomy for an operative classification of liver injuries. Ann Surg . 1990; 211 669-673
4 Feliciano D V, Mattox K L, Jordan Jr L G, Burch J M, Bitondo C G, Cruse P A. Management of 1000 consecutive cases of hepatic trauma (1979-1984). Ann Surg . 1986; 204 438-445
5 Pachter H L, Feliciano D V. Complex hepatic injuries. Surg Clin North Am . 1996; 76 763-782
6 Lin Q. Analysis of 133 patients with severe blunt liver injury. Chin J Traumatol . 2001; 4 120-122
7 Cogbill T H, Moore E E, Jurkovich G J, Feliciano D V, Morris J A, Mucha P. Severe hepatic trauma: a multi-center experience with 1,335 liver injuries. J Trauma . 1988; 28 1433-1438
8 Parks R W, Chrysos E, Diamond T. Management of liver trauma. Br J Surg . 1999; 86 1121-1135
9 Jurkovich G J, Hoyt D B, Moore F A. et al . Portal triad injuries. J Trauma . 1995; 39 426-434
10 Johnson J W, Gracias V H, Gupta R. et al . Hepatic angiography in patients undergoing damage control laparotomy. J Trauma . 2002; 52 1102-1106
11 Rodriguez-Montes J A, Rojo E, Martin L G. Complications following repair of extrahepatic bile duct injuries after blunt abdominal trauma. World J Surg . 2001; 25 1313-1316
12 Du D, Gao J, Tian X. Diagnosis and treatment of post-traumatic biliary leakage. Chin J Traumatol . 1998; 15 37-40
13 Hollands M J, Little J M. Post-traumatic bile fistulae. J Trauma . 1991; 31 117-120
14 Sugiyama M, Atomi Y, Matsuoka T, Yamaguchi Y. Endoscopic biliary stenting for treatment of persistent biliary fistula after blunt hepatic injury. Gastrointest Endosc . 2000; 51 42-44
15 Church N G, May G, Sigalet D L. A minimally invasive approach to bile duct injury after blunt liver trauma in pediatric patients. J Pediatr Surg . 2002; 37 773-775
16 De Backer A, Fierens H, De Schepper A, Pelckmans P, Jorens P G, Vaneerdeweg W. Diagnosis and nonsurgical management of bile leak complicated by biloma after blunt liver injury: report of two cases. Eur Radiol . 1998; 8 1619-1622
17 Sze D Y, Vestring T, Liddell R P. et al . Recurrent TIPS failure associated with biliary fistulae: treatment with PTFE-covered stents. Cardiovasc Intervent Radiol . 1999; 22 298-304
18 Patel R I, Shapiro M J. Biliary venous fistula: an unusual complication of fine-needle aspiration biopsy of the liver. J Vasc Interv Radiol . 1995; 6 953-956
19 Blum U, Buitrago-Tellez C, el Seif M, Wimmer B. Posttraumatic bilhemia: conservative management by percutaneous drainage. Cardiovasc Intervent Radiol . 1993; 16 55-57
20 Ernst O, Sergent G, Mizrahi D, Delemazure O, L'Hermine C. Biliary leaks: treatment by means of percutaneous transhepatic biliary drainage. Radiology . 1999; 211 345-348
21 Venbrux A C, Osterman Jr A F. Percutaneous management of benign biliary strictures. Tech Vasc Interv Radiol . 2001; 4 141-146
22 Gabelmann A, Hamid H, Brambs H J, Rieber A. Metallic stents in benign biliary strictures: long-term effectiveness and interventional management of stent occlusion. AJR Am J Roentgenol . 2001; 177 813-817
23 Feliciano D V, Bitondo C G, Burch J M, Mattox K L, Beall Jr C A, Jordan Jr L G. Management of traumatic injuries to the extrahepatic biliary ducts. Am J Surg . 1985; 150 705-709