Eur J Pediatr Surg 2021; 31(03): 245-251
DOI: 10.1055/s-0040-1710391
Original Article

Fifteen-Year Single-Center Experience of Biliary Complications in Liver Trauma Patients: Changes in the Management of Posttraumatic Bile Leak

Stephen Stonelake
1   Birmingham Children's Hospital NHS Foundation Trust, Paediatric Surgery, Birmingham, United Kingdom
,
Sana Ali
2   Radiology Department, Birmingham Children’s Hospital, Birmingham, United Kingdom
,
Benjamin Pinkey
2   Radiology Department, Birmingham Children’s Hospital, Birmingham, United Kingdom
,
Evelyn Ong
3   Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
,
Ravindar Anbarasan
1   Birmingham Children's Hospital NHS Foundation Trust, Paediatric Surgery, Birmingham, United Kingdom
,
Simon McGuirk
2   Radiology Department, Birmingham Children’s Hospital, Birmingham, United Kingdom
,
Thamera Perera
3   Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
,
Darius Mirza
3   Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
,
Paolo Muiesan
3   Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
,
Khalid Sharif
3   Birmingham Children's Hospital, The Liver Unit, Birmingham, United Kingdom
› Author Affiliations
Funding None.

Abstract

Introduction Management of posttraumatic bile leak has evolved over time in our unit, from endoscopic retrograde cholangiopancreatography (ERCP) stenting to intraperitoneal drainage (IPD) alone as first-line treatment for intraperitoneal bile leak.

Materials and Methods Retrospective review of liver trauma patients from 2002 to 2017. Demographics, time and mode of diagnosis of bile leak, management, and outcome were analyzed of the box plot.

Results In 118 patients, there were 28 traumatic bile leaks. Eighteen were free intraperitoneal and 10 were localized bilomas. The median time of diagnosis was 6 days following injury. The modes of diagnosis were preemptive hepatobiliary scintigraphy (18), computed tomography (CT) or ultrasound (7), and laparotomy (3). Free intraperitoneal biliary leak management included 11 IPD alone, 3 IPD plus ERCP, 2 IPD plus transcystic biliary stent (TBS), 1 operative cholangiogram, and 1 no intervention. Median time of IPD duration was 7 days (4–95) in IPD alone versus 14 days (6–40) in IPD + ERCP/TBS (p = 0.3). Median inpatient length of stay was 13 days (8–44) in IPD alone versus 12 days (8–22) in IPD + ERCP/TBS (p = 0.4).

Conclusion Placement of IPD alone, as first-line treatment, is safe and effective in the management of intraperitoneal bile leaks, avoiding the costs and potential complications of ERCP.



Publication History

Received: 21 January 2020

Accepted: 07 April 2020

Publication Date:
18 May 2020 (online)

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