Endoscopic management of traumatic bile leaks

Abstract

Background: Traumatic bile leaks often result in prolonged morbidity and an increased length of hospital stay that requires multimodality management. Data on endoscopic management of traumatic bile leaks are scarce.

Objective: To evaluate the efficacy of endotherapy in the management of traumatic bile leaks.

Design: Retrospective evaluation of prospectively collected data.

Setting: Tertiary academic referral center.

Patients: Consecutive patients referred for ERCP after traumatic abdominal injury for the management of bile leaks.

Interventions: Biliary stent placement at ERCP.

Main outcome measures: Resolution of a bile leak on follow-up ERCP.

Results: Ten patients underwent ERCP for the management of a traumatic bile leak over a 3-year period. The etiology included a penetrating injury from a gunshot wound in 5 patients, blunt injuries from a motor vehicle accident in 4 patients, and injury secondary to a fall in 1 patient. Liver injuries were grade II in 1 patient, grade IV in 7 patients, and grade V in 2 patients. A bile leak was treated by biliary stent placement in all patients, and the outcome was successful in 9 of 10 cases (90%). The mean duration of follow-up was 337 days (range, 101-821 days). Nine of 10 patients underwent surgery to control bleeding or other associated injuries. There were no ERCP-related complications.

Limitations: Small number of patients.

Conclusions: Consideration should be given to incorporate ERCP as first-line therapy in management of traumatic bile leaks, because endobiliary stent placement provides a successful outcome in a majority of cases, irrespective of the severity of injury.