An Unusual Recurrent Bile Leak Following High Grade Liver Trauma

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.

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P7 A review of the understanding and use of the Regional Liver Trauma Guidelines

BJS Open ◽

10.1093/bjsopen/zrab032.006 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Rohan Thakkar ◽

Khaled Ammar ◽

Ellen Meredith ◽

Michael Jones ◽

Ellen Meredith ◽

...

Keyword(s):

Regional Distribution ◽

Bile Leak ◽

Operative Management ◽

Liver Trauma ◽

Trauma Patients ◽

North East ◽

The North ◽

Close Observation ◽

Patient’S Outcome ◽

Non Operative Management

Abstract Introduction The liver is the most commonly injured intra-abdominal organ and occurs in 30% of patients undergoing laparotomy for penetrating injuries and in 15–20% of laparotomies for blunt injuries. CT scan is the investigation of choice for accurate diagnosis and categorization of hepatic injury. Management of isolated liver trauma can be by operative or non-operative management, guided mainly by haemodynamic stability of the patient irrespective to category of injury. Close observation of patients undergoing non-operative management is important; they may develop early complications that require operative intervention, including bleeding, bile leak and peritonitis. Methods A questionnaire will be sent to the General Surgery consultants and registrars within the North East of England, a region with eleven hospitals taking General Surgical admissions, two of which are regional trauma centres. This is to assess the understanding of liver trauma classification and management and their familiarity with and adherence to the regional liver trauma guidelines. Following this, the guidelines will be distributed throughout the region with accompanying teaching sessions. A follow up questionnaire will determine the improvement of regional knowledge and use of the guidelines. In parallel, the outcome of liver trauma patients within the region will be sought to look for correlation between the education and the patient’s outcome. Results Regional distribution of the results will demonstrate the change in the education of liver trauma management and the subsequent change in patient’s outcome. Results will be recorded using Excel and analysed using SPSS statistical software.

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Endoscopic Retrograde Cholangiopancreatography Is an Effective Treatment for Bile Leak After Severe Liver Trauma

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3181efc270 ◽

2011 ◽

Vol 71 (2) ◽

pp. 480-485 ◽

Cited By ~ 23

Author(s):

Rahul J. Anand ◽

Paula A. Ferrada ◽

Peter E. Darwin ◽

Grant V. Bochicchio ◽

Thomas M. Scalea

Keyword(s):

Effective Treatment ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Bile Leak ◽

Liver Trauma ◽

Severe Liver ◽

Endoscopic Retrograde

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Management of Traumatic Liver and Bile Duct Laceration

Euroasian Journal of Hepato-Gastroenterology ◽

10.5005/jp-journals-10018-1247 ◽

2017 ◽

Vol 7 (2) ◽

pp. 188-190 ◽

Cited By ~ 2

Author(s):

Pankaj Dwivedi ◽

Mukta Waghmare ◽

Hemanshi Shah ◽

Charu Tiwari ◽

Kiran Khedkar

Keyword(s):

Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Blunt Abdominal Trauma ◽

Percutaneous Drainage ◽

Hepatic Duct ◽

Bile Leak ◽

Liver Trauma ◽

High Grade ◽

Hepatic Trauma ◽

Endoscopic Retrograde

ABSTRACT Posttraumatic major bile leak in children is uncommon, with few cases reported in the literature. These injuries are seen in high-grade liver trauma and are difficult to diagnose and manage. We describe a 7-year-old boy with grade IV hepatic trauma and bile leak following blunt abdominal trauma. The leak was successfully managed by percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP) stenting of the injured hepatic duct. How to cite this article Tiwari C, Shah H, Waghmare M, Khedkar K, Dwivedi P. Management of Traumatic Liver and Bile Duct Laceration. Euroasian J Hepato-Gastroenterol 2017;7(2):188-190.

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Evolution of non-operative management of liver trauma

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000551 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000551

Author(s):

Adam Brooks ◽

John-Joe Reilly ◽

Carla Hope ◽

Alex Navarro ◽

Paal Aksel Naess ◽

...

Keyword(s):

Mortality Rate ◽

Liver Injury ◽

Patient Selection ◽

Survival Rates ◽

Operative Management ◽

Liver Trauma ◽

Severe Liver ◽

Injury Management ◽

Non Operative Management ◽

Rate Of Failure

The management of complex liver injury has changed during the last 30 years. Operative management has evolved into a non-operative management (NOM) approach, with surgery reserved for those who present in extremis or become hemodynamically unstable despite resuscitation. This NOM approach has been associated with improved survival rates in severe liver injury and has been the mainstay of treatment for the last 20 years. Patients that fail NOM and require emergency surgery are associated with increased morbidity and mortality. Better patient selection may have an impact not only on the rate of failure of NOM, but the mortality rate associated with it. The aim of this article is to review the evidence that helped shape the evolution of liver injury management during the last 30 years.

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Endoscopic retrograde cholangiopancreatography for bile leak after severe liver trauma

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31823dbaf1 ◽

2012 ◽

Vol 72 (2) ◽

pp. 537 ◽

Cited By ~ 2

Author(s):

Charles E. Lucas

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Bile Leak ◽

Liver Trauma ◽

Severe Liver ◽

Endoscopic Retrograde

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Endoscopic Fistulotomy – ‘The Suprapapillary Punch’: A Method of Access to the Bile Duct during ERCP

Canadian Journal of Gastroenterology ◽

10.1155/1994/497470 ◽

1994 ◽

Vol 8 (1) ◽

pp. 33-35

Author(s):

Noel B Hershfield

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Biliary Tree ◽

Usual Method ◽

Endoscopic Retrograde ◽

The Common ◽

A Minor ◽

Endoscopic Fistulotomy

Endoscopic retrograde cholangiopancreatography (ERCP) is established as the method of choice to investigate the biliary tree when obstruction is suspected. On rare occasions, the papilla cannot be entered because of anatomical or pathological abnormalities. This report describes endoscopic fistulotomy or the suprapapillary punch that has been carried out at the Foothills Hospital in Calgary, Alberta, on 30 of 623 patients referred for ERCP for conditions causing obstruction of the common bile duct or suspected obstruction of the common bile duct. The following communication also describes the method of suprapapillary punch or endoscopic fistulotomy. Results have been excellent with only one complication, a minor attack of pancreatitis after the procedure. In summary, the suprapapillary punch or fistulotomy is a safe and useful method for entering the common bile duct when access by the usual method is impossible.

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Traumatic Liver Injury in Hong Kong: The Management Strategy and Outcome

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790901600403 ◽

2009 ◽

Vol 16 (4) ◽

pp. 208-216 ◽

Cited By ~ 1

Author(s):

CN Chong ◽

YS Cheung ◽

KF Lee ◽

TH Rainer ◽

BSP Lai

Keyword(s):

Hong Kong ◽

Liver Injury ◽

Hospital Stay ◽

Injury Severity ◽

Road Traffic ◽

Demographic Data ◽

Operative Management ◽

Concomitant Injuries ◽

Significant Difference ◽

Non Operative Management

Introduction Management of liver injury is challenging and evolving. The aim of this article is to review the outcome of traumatic liver injury in Chinese people in Hong Kong. Materials & methods Records of 40 patients with hepatic injury who received treatment at the Prince of Wales Hospital between December 2000 and May 2005 were reviewed. Demographic data, severity of liver injury, Injury Severity Score (ISS), haemodynamic status and Glasgow Coma Scale (GCS) score on admission, investigations made, concomitant injuries, management scheme, and outcome of patients were analysed. Results There were 23 male and 17 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (65%). Half of the patients were treated by non-operative management (NOM). None of them required surgery during subsequent management. Patients in the operative management (OM) group had a significantly higher ISS (p=0.026), but there was no significant difference in the mortality rate between the OM and NOM groups. Patients with stable haemodynamic status and who were treated non-operatively had a significantly shorter hospital stay (p=0.006). High grade liver injury (OR=8.0, 95% CI=1.2 to 53.8, p=0.03) and ISS greater than 25 (OR=21.6, 95% CI=2.0 to 225.3, p=0.01) were independent risk factors for mortality on multivariate analysis. Conclusions Non-operative management of liver injury can be safely accomplished in haemodynamically stable patients, with the possible benefit of a shorter hospital stay.

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