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Semin intervent Radiol 2003; 20(2): 141-150
DOI: 10.1055/s-2003-43318
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

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
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Publication History

Publication Date:
31 October 2003 (online)

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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

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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Pachter H L, Feliciano D V. Complex hepatic injuries.  Surg Clin North Am . 1996;  76 763-782
    CrossrefPubMedGoogle Scholar
  • 6 Lin Q. Analysis of 133 patients with severe blunt liver injury.  Chin J Traumatol . 2001;  4 120-122
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 8 Parks R W, Chrysos E, Diamond T. Management of liver trauma.  Br J Surg . 1999;  86 1121-1135
    CrossrefPubMedGoogle Scholar
  • 9 Jurkovich G J, Hoyt D B, Moore F A. et al . Portal triad injuries.  J Trauma . 1995;  39 426-434
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Du D, Gao J, Tian X. Diagnosis and treatment of post-traumatic biliary leakage.  Chin J Traumatol . 1998;  15 37-40
    PubMedGoogle Scholar
  • 13 Hollands M J, Little J M. Post-traumatic bile fistulae.  J Trauma . 1991;  31 117-120
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 21 Venbrux A C, Osterman Jr A F. Percutaneous management of benign biliary strictures.  Tech Vasc Interv Radiol . 2001;  4 141-146
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar