Complications of high grade liver injuries: management and outcome with focus on bile leaks
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine,

Bala M et al. – A high complication rate following high–grade liver injuries should be anticipated. In patients with clinical evidence of biliary complications, CT scan is a useful diagnostic and therapeutic tool. AE, ERCP and temporary internal stenting, together with percutaneous drainage of intra–abdominal or intrahepatic bile collections, represents a safe and effective strategy for the management of complications following both blunt and penetrating hepatic trauma.

Methods
  • This is a retrospective study of patients with liver injury admitted to Hadassah-Hebrew University Medical Centre over a 10-year period.
  • Grade 3-5 injuries were considered to be high grade.
  • Collected data included the number and types of liver-related complications.
  • Interventions which were required for these complications in patients who survived longer than 24 hours were analysed.

Results
  • Of 398 patients with liver trauma, 64 (16%) were found to have high-grade liver injuries.
  • Mechanism of injury was blunt trauma in 43 cases, and penetrating in 21.
  • Forty patients (62%) required operative treatment.
  • Among survivors 22 patients (47.8%) developed liver-related complications which required additional interventional treatment.
  • Bilomas and bile leaks were diagnosed in 16 cases post-injury.
  • The diagnosis of bile leaks was suspected with abdominal CT scan, which revealed intraabdominal collections (n=6), and ascites (n=2).
  • Three patients had continuous biliary leak from intraabdominal drains left after laparotomy.
  • Nine patients required ERCP with biliary stent placement, and 2 required percutaneous transhepatic biliary drainage.
  • ERCP failed in one case.
  • Four angioembolizations (AE) were performed in 3 patients for rebleeding.
  • Surgical treatment was found to be associated with higher complication rate.
  • AE at admission was associated with a significantly higher rate of biliary complications.
  • There were 24 deaths (37%), the majority from uncontrolled haemorrhage (18 patients).
  • There were only 2 hepatic-related mortalities due to liver failure.

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