Endoscopic management of traumatic bile leaks.
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.


METHODS
Retrospective evaluation of prospectively collected data.


METHODS
Tertiary academic referral center.


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


METHODS
Biliary stent placement at ERCP.


METHODS
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.


CONCLUSIONS
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.
Bridges
Allison
A
Pancreaticobiliary Unit, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.
Wilcox
C Mel
CM
Varadarajulu
Shyam
S
D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014950:Wounds, Penetrating / Q000150:complications* / Q000175:diagnosis / Q000601:surgery