Screening and management of major bile leak after blunt liver trauma: a retrospective single
center study
Sammanfattning
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 ?
mol/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 ?mol/L during admission.