title: Screening and management of major bile leak after blunt liver trauma: a retrospective single center study.
abstract: BACKGROUND
  Major bile leak after blunt liver trauma is rare but challenging. It usually requires endoscopic retrograde cholangiography (ERC) for management. However, there is still lack of specific indications. The aim of this study is to elucidate risk factors for major bile leak and indications for early ERC after blunt liver trauma.
  
  
  METHODS
  The trauma registry of a level I trauma center in Taiwan was queried, and all blunt liver trauma patients from June, 2008 to June, 2011 were selected for retrospective review. Data collected included demographic data, laboratory data, Injury Severity Score (ISS), liver injury grade and location, management of liver trauma, length of ICU, hospital stay and treatment result. ERC was used to confirm major bile leak.
  
  
  RESULTS
  288 blunt liver trauma patients were selected from 2,475 torso trauma patients. There were 214 (74.5%) male and 74 (25.7%) female patients. The mean ISS was 24.2. Most patients received conservative treatment. Transcatheter artery embolization (TAE) and operation were 15.6% and 10.8% respectively. Major bile leak occurred in 14 (4.9%) patients. Risk factors for bile leak include high-grade liver injury, centrally-located liver trauma and use of TAE. A bilirubin level greater than 43.6 μmol/L provides a sensitivity of 100% and specificity of 85.1% for predicting major bile leak.
  
  
  CONCLUSIONS
  High injury grade; centrally-located liver trauma; and use of TAE are risk factors for major bile leak after blunt liver trauma. ERC should be arranged early if the patient has risk factors and their plasma bilirubin level is greater than 43.6 μmol/L during admission.
authors.forename: Kuo-Ching
authors.initials: KC
authors.lastname: Yuan
authors.forename: Yon-Cheong
authors.initials: YC
authors.lastname: Wong
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Kang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, No,5, Fusing St, Gueishan Township Taoyuan County 333, Taiwan. bifida@ms4.hinet.net.
authors.forename: Yu-Pao
authors.initials: YP
authors.lastname: Hsu
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D001652:Bile Ducts / Q000293:injuries*; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
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