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.
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.
Authors: Christina A LeBedis; Stephan W Anderson; Gustavo Mercier; Steven Kussman; Stephanie L Coleman; Louis Golden; David R Penn; Jennifer W Uyeda; Jorge A Soto Journal: Emerg Radiol Date: 2014-08-22