Biloma and biliary fistula associated with hepatorrhaphy for liver injury
Shahrudin, M.D.; Noori, S.M.
Hepato-Gastroenterology 44(14): 519-521
1997
ISSN/ISBN: 0172-6390 PMID: 9164529 Document Number: 480028
Background/Aims: To review our experience in managing post-hepatorrhaphy complications in liver trauma. Materials and Methods: During the period of 1986-1994, 6250 trauma patients were admitted to the Accident and Emergency Unit of the University Hospital Kuala Lumpur. The medical records were reviewed. There were 175 patients with liver trauma requiring hepatorrhaphy. The major post-operative complications (biloma and biliary fistula) were noted. We reviewed and discussed the various management of these biliary complications. Results: Eleven patients developed either a biloma, biliary fistula or both. Patients age ranged from 15 to 40 years with a mean ISS of 23. Seven patients suffered penetrating injury and 4 were victims of blunt trauma. The right lobe was injured in 10 patients, with 1 patient sustaining left lobe injury. All liver injuries were either grade 3 (7 patients) or grade 4 (4 patients). No patient sustained extrahepatic biliary tract injury. Biloma and fistulas were diagnosed 14-30 days post-injury (mean 24 days) by CT or HIDA scans. All were managed by CT-guided percutaneous drainage. One patient also required percutaneous transhepatic cholangiography with biliary stent placement due to bile-stained ascites. Fistulas persisted from 5-120 days (mean 44 days). No patient required further operative intervention all fistula closed spontaneously without complication. Conclusion: Uncomplicated biliary fistula posthepatectomy for liver trauma can be treated with percutaneous drainage.