Abstract
Bile leaks are rare but potentially devastating iatrogenic or posttraumatic complications.
This is being diagnosed more frequently since the advent of laparoscopic cholecystectomy
and propensity toward nonsurgical management in select trauma patients. Timely recognition
and accurate characterization of a bile leak is crucial for favorable patient outcomes
and involves a multimodal imaging approach. Management is driven by the type and extent
of the biliary injury and requires multidisciplinary cooperation between interventional
radiologists, endoscopists, and hepatobiliary/transplant surgeons. Interventional
radiologists have a vital role in both the diagnosis and management of bile leaks.
Percutaneous interventional procedures aid in the characterization of a bile leak
and in its initial management via drainage of fluid collections. Most bile leaks resolve
with decompression of the biliary system which is routinely done via endoscopic retrograde
cholangiopancreaticography. Some bile leaks can be definitively treated percutaneously
while others necessitate surgical repair. The primary principle of percutaneous management
is flow diversion away from the site of a leak with the placement of transhepatic
biliary drainage catheters. While this can be accomplished with relative ease in some
cases, others call for more advanced techniques. Bile duct embolization or sclerosis
may also be required in cases where a leaking bile duct is isolated from the main
biliary tree.
Keywords
bile leak - percutaneous transhepatic cholangiography - bile duct injury
