title: Iatrogenic, blunt, and penetrating trauma to the biliary tract.
abstract: Iatrogenic and traumatic bile leaks are uncommon. However, given the overall increase in number of hepatobiliary surgeries and the paradigm shift toward nonoperative management of patients with liver trauma, they have become more prevalent in recent years. Imaging is essential to establishing early diagnosis and guiding treatment as the clinical signs and symptoms of bile leaks are nonspecific, and a delay in recognition of bile leaks portends a high morbidity and mortality rate. Findings suspicious for a bile leak at computed tomography or ultrasonography include free or contained peri- or intrahepatic low density fluid in the setting of recent trauma or hepatobiliary surgery. Hepatobiliary scintigraphy and magnetic resonance cholangiopancreatography (MRCP) with hepatobiliary contrast agents can be used to detect active or contained bile leak. MRCP with hepatobiliary contrast agents has the unique ability to reveal the exact location of bile leak, which often governs whether endoscopic management or surgical management is warranted. Percutaneous transhepatic cholangiography and fluoroscopy via an indwelling catheter that is placed either percutaneously or surgically are useful modalities to guide percutaneous transhepatic biliary drain placement which can provide biliary drainage and/or diversion in the setting of traumatic biliary injury. Surgical treatment of a bile duct injury with Roux-en-Y hepaticojejunostomy is warranted if definitive treatment cannot be accomplished through percutaneous or endoscopic means.
authors: Department of Radiology, Boston University Medical Center, 820 Harrison Avenue 3rd Floor, Boston, MA, 02118, USA. christina.lebedis@bmc.org.
authors: Christina A
authors: 0000-0002-8849-736X
authors: CA
authors: LeBedis
authors: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors: David D B
authors: DDB
authors: Bates
authors: Department of Radiology, Boston University Medical Center, 820 Harrison Avenue 3rd Floor, Boston, MA, 02118, USA.
authors: Jorge A
authors: JA
authors: Soto
mesh_terms: D001659:Biliary Tract / Q000000981:diagnostic imaging* / Q000293:injuries*; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease
keywords: Biliary injury; Blunt trauma; Iatrogenic injury; Penetrating trauma