title: Management of biliary complications following damage control surgery for liver trauma.
abstract: BACKGROUND
  The liver is the most frequently injured solid intra-abdominal organ. The major cause of early death following severe liver trauma is exsanguination. Although perihepatic packing improves survival in severe liver trauma, this leaves parenchymal damage untreated, often resulting in post-traumatic biliary leakage and a subsequent rise in morbidity. The aim of this study was to analyze the incidence and treatment of biliary leakage following the operative management of liver trauma.
  
  
  METHODS
  Patients presenting between 2000 and 2009 to Erasmus University Medical Centre with traumatic liver injury were identified. Data from 125 patients were collected and analyzed. Sixty-eight (54 %) patients required operation. All consecutive patients with post-operative biliary complications were analyzed. Post-operative biliary complications were defined as biloma, biliary fistula, and bilhemia.
  
  
  RESULTS
  Ten (15 %) patients were diagnosed with post-operative biliary leakage following liver injury. Three patients with a biloma were treated with percutaneous drainage, without further intervention. Seven patients with significant biliary leakage were managed by endoscopic stenting of the common bile duct to decompress the internal biliary pressure. One patient had a relaparotomy and right hemihepatectomy to control biliary leakage and injury of the right hepatic duct.
  
  
  CONCLUSIONS
  Biliary complications continue to occur frequently following damage control surgery for liver trauma. The majority of biliary complications can be managed without an operation. Endoscopic retrograde cholangiopancreatography (ERCP) and internal stenting represent a safe strategy to manage post-operative biliary leakage and bilhemia in patients following liver trauma. Minor biliary leakage should be managed by percutaneous drainage alone.
authors.affiliation: Erasmus University Medical Center, Rotterdam, The Netherlands. hommesmartijn@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Hommes
authors.affiliation: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Kazemier
authors.affiliation: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: N W L
authors.initials: NW
authors.lastname: Schep
authors.affiliation: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.affiliation: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: I B
authors.initials: IB
authors.lastname: Schipper
keywords: Biliary complications; Damage control surgery; Liver trauma
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