Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov;42(11):3705-3714.
doi: 10.1007/s00268-018-4621-y.

Preliminary Report of Percutaneous Cholecystostomy as Diagnosis and Treatment of Biliary Tract Trauma

Jean-Baptiste Cazauran  1 , Arnaud Muller  2 , Baptiste Hengy  3 , Pierre-Jean Valette  2 , Laurent Gruner  1 , Olivier Monneuse  4
Affiliations

Preliminary Report of Percutaneous Cholecystostomy as Diagnosis and Treatment of Biliary Tract Trauma

Jean-Baptiste Cazauran et al. World J Surg. 2018 Nov.

Abstract

Background: Biliary leak following severe blunt liver injuries is a complex problem becoming more frequent with improvements in non-operative management. Standard treatment requires main bile duct drainage usually performed by endoscopic sphincterotomy and stent placement. We report our experience with cholecystostomy as a first minimally invasive diagnostic and therapeutic approach.

Methods: We performed a retrospective analysis of consecutive patients with post-traumatic biliary leak between 2006 and 2015. In the first period (2006-2010), biliary fistula was managed using perihepatic drainage and endoscopic, percutaneous or surgical main bile duct drainage. After 2010, cholecystostomy as an initial minimally invasive approach was performed.

Results: Of 341 patients with blunt liver injury, 18 had a post-traumatic biliary leak. Ten patients received standard treatment and eight patients underwent cholecystostomy. The cholecystostomy (62.5%) and the standard treatment (80%) groups presented similar success rates as the first biliary drainage procedure (p = 0.41). Cholecystostomy presented no severe complications and resulted, when successful, in a bile flow rate inversion between the perihepatic drains and the gallbladder drain within a median [IQR] 4 days [1-7]. The median time for bile leak resolution was 26 days in the cholecystostomy group and 39 days in the standard treatment group (p = 0.09). No significant difference was found considering median duration of hospital stay (54 and 74 days, respectively, p = 0.37) or resuscitation stay (17.5 and 19.5 days, p = 0.59).

Conclusion: Cholecystostomy in non-operative management of biliary fistula after blunt liver injury could be an effective, simple and safe first-line procedure in the diagnostic and therapeutic approach of post-traumatic biliary tract injuries.

PubMed Disclaimer

References

    1. Leppäniemi AK, Mentula PJ, Streng MH et al (2011) Severe hepatic trauma: nonoperative management, definitive repair, or damage control surgery? World J Surg 35:2643–2649. https://doi.org/10.1007/s00268-011-1309-y - DOI - PubMed
    1. Stassen NA, Bhullar I, Cheng JD et al (2012) Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73:S288–S293. https://doi.org/10.1097/ta.0b013e318270160d - DOI - PubMed
    1. Kozar RA, Moore JB, Niles SE et al (2005) Complications of nonoperative management of high-grade blunt hepatic injuries. J Trauma 59:1066–1071 - DOI
    1. Bala M, Gazalla SA, Faroja M et al (2012) Complications of high grade liver injuries: management and outcome with focus on bile leaks. Scand J Trauma Resusc Emerg Med 20:20 - DOI
    1. Anand RJ, Ferrada PA, Darwin PE et al (2011) Endoscopic retrograde cholangiopancreatography is an effective treatment for bile leak after severe liver trauma. J Trauma Inj Infect Crit Care 71:480–485. https://doi.org/10.1097/ta.0b013e3181efc270 - DOI

LinkOut - more resources