Bile duct leaks from the intrahepatic biliary tree: a review of its etiology, incidence, and management

Abstract

Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management.

Figure 1

ERCP demonstrating bile leak in a patient who had cyst evacuation done for Hydatid cyst of the right lobe of liver.

Figure 2

Classification based management of intrahepatic bile leaks.

Figure 3

CT scan showing a biloma surrounding the ablated tumor after RF ablation.

Figure 4

ERCP demonstrating bile leak into the abscess cavity after percutaneous liver abscess drainage.

Figure 5

CT scan showing large hematoma in Right lobe of liver following blunt trauma. The hematoma was complicated by bilhemia.

Figure 6

ERCP demonstrating bile leak following liver laceration. The patient was managed conservatively with endoscopic stent placement.