Elimination of bile leakage in liver injuries

   Aim. To study the causes and consequences of bile leakage in liver injury and determine the potential ways for its elimination.

   Materials and methods. The study involved a retrospective analysis of 204 liver injuries of various types. 26 % of cases were detected with isolated abdominal trauma, 74 % – with concomitant abdominal injury. According to the AAST grading scale, 15.7 % of patients got grade II liver injuries, 44.6 % – grade III, 34.3 % – grade IV, and 5.4 % – grade V. Since concomitant injuries predominated, surgical treatment was initially performed in the overwhelming number of cases. 14 % of cases received non-operative management.

   Results. The incidence of bile leakage amounted to 28.4 % for all liver injuries and reached 54.9 % for III–V grade injuries (AAST). Small bile leakage prevailed, while active leaking was observed in 36.2 %. Damage to peripheral parts of the biliary tract was noted in most cases (68 %). Conservative management of patients with small bile leakage associated with damage to peripheral parts of the biliary tract appeared successful in 48.5 % of cases. Endoscopic biliary drainage of bile ducts proved effective in case of active bile leakage and (or) injuries of the central bile ducts.

   Conclusion. Endoscopic biliary drainage of bile ducts is considered the most effective for elimination of active biliary leakage in the absence of biliary peritonitis and communication of biliary tract with pleural cavity.

1. Ergashev O.N., Goncharov A.V., Bogarev A.S., Vinogradov Y.M. Diagnostics and treatment of liver damage in casualties with severe concomitant injury. Disaster Medicine. 2011; 2 (74): 23–28. (In Russian)

2. Zhakiev B.S., Kurmagaliev O.M., Kurmanbaev B.A., Zhanabaev B.K., Imzharov A.T. Mistakes in the diagnosis and treatment of thoraco-abdominal wound with cross-cutting injury in the liver and subdiaphragmal aorta. Medical Journal of West Kazakhstan. 2018; 60 (4): 53–56. (In Russian)

3. Novozhilov A.V., Savosin D.V., Grigoriev S.E., Grigoriev E.G. Surgical treatment of posttraumatic intrahepatic biliovenous fistula. Polytrauma. 2022; 1: 67–71. (In Russian)

4. Diarra D., Salam S., Salihou A., Traore B., Laoudiyi D., Chbani K., Ouzidane L.E. Post-traumatic biloma intrahepatic a rare complication of closed abdominal trauma: a case report. Radiol. Case Rep. 2022; 17 (6): 2203–2206. doi: 10.1016/j.radcr.2022.02.059

5. Podoluzhny V.I., Radionov I.A., Peltz V.A., Startsev A.B., Krasnov K.A., Shatalin V.A. Traumatic liver injuries. Polytrauma. 2023; 1: 34–38. (In Russian)

6. Søndenaa K., Horn A., Nedrebø T. Diagnosis of blunt trauma to the gallbladder and bile ducts. Eur. J. Surg. 2000; 166: 903–907. doi: 10.1080/110241500447326

7. Degiannis E., Khelif K., Leandros E., Boffard K., Saadia R. Gunshot injuries of the extrahepatic biliary ducts. Eur. J. Surg. 2001; 167: 618–621. doi: 10.1080/110241501753171236

8. Kagoura M., Monden K., Sadamori H., Hioki M., Ohno S., Takakura N. Outcomes and management of delayed complication after severe blunt liver injury. BMC Surgery. 2022; 1–9. doi: 10.1186/s12893-022-01691-z

9. Oo J., Smith M., Ban E.J., Clements W., Tagkalidis P., Fitzgerald M., Pilgrim C.H.C. Management of bile leak following blunt liver injury: a proposed guideline. ANZ J. Surg. 2021; 91 (6): 1164–1169. doi: 10.1111/ans.16552

10. Yuan K.C., Wong Y.C., Fu C.Y., Chang C.J., Kang S.C., Hsu Y.P. Screening and management of major bile leak after blunt liver trauma: a retrospective single center study. Scand. J. Trauma Resusc. Emerg. Med. 2014; 22: 26. doi: 10.1186/1757-7241-22-26

11. Melamud K., LeBedis C.A., Anderson S.W., Soto J.A. Biliary imaging: multimodality approach to imaging of biliary injuries and their complications. Radiographics. 2014; 34 (3): 613–623. doi: 10.1148/rg.343130011

12. Bridges A., Wilcox C.M., Varadarajulu S. Endoscopic management of traumatic bile leaks. Gastrointest. Endosc. 2007; 65 (7): 1081–1085. doi: 10.1016/j.gie.2006.11.038

13. Coccolini F., Catena F., Moore E.E., Ivatury R., Biffl W., Peitzman A., Coimbra R., Rizoli S., Kluger Y., Abu-Zidan F.M., Ceresoli M., Montori G., Sartelli M., Weber D., Fraga G., Naidoo N., Moore F.A., Zanini N., Ansaloni L. WSES classification and guidelines for liver trauma. World J. Emerg. Surg. 2016; 11: 50. doi: 10.1186/s13017-016-0105-2

14. Coccolini F., Coimbra R., Ordonez C., Kluger Y., Vega F., Moore E.E., Biffl W., Peitzman A., Horer T., Abu-Zidan F.M., Sartelli M., Fraga G.P., Cicuttin E., Ansaloni L., Parra M.W., Millán M., DeAngelis N., Inaba K., Velmahos G., Maier R., Khokha V., Sakakushev B., Augustin G., di Saverio S., Pikoulis E., Chirica M., Reva V., Leppaniemi A., Manchev V., Chiarugi M., Damaskos D., Weber D., Parry N., Demetrashvili Z., Civil I., Napolitano L., Corbella D., Catena F. WSES expert panel. Liver trauma: WSES 2020 guidelines. World J. Emerg. Surg. 2020; 15 (1): 24. doi: 10.1186/s13017-020-00302-7

15. Ibaldinin A.S., Kravtsov V.I. Diagnosis and surgical tactics in isolated and combined liver injury. Practical Medicine. 2013; 2 (67): 49–51. (In Russian)

16. Hommes M., Nicol A.J., Navsaria P.H., Reinders Folmer E., Edu S., Krige J.E. Management of biliary complications in 412 patients with liver injuries. J. Trauma Acute Care Surg. 2014; 77 (3): 448–451. doi: 10.1097/TA.0000000000000335

17. Starling S.V., de Azevedo C.I., Santana A.V., Rodrigues Bde L., Drumond D.A. Isolated liver gunshot injuries: nonoperative management is feasible? Rev. Col. Bras. Cir. 2015; 42 (4): 238–243. doi: 10.1590/0100-69912015004008

18. Stonelake S., Ali S., Pinkey B., Ong E., Anbarasan R., McGuirk S., Perera T., Mirza D., Muiesan P., Sharif K. Fifteen-Year single-center experience of biliary complications in liver trauma patients: changes in the management of posttraumatic bile leak. Eur. J. Pediatr. Surg. 2021; 31 (3): 245–251. doi: 10.1055/s-0040-1710391

19. Bushlanov P.S., Merzlikin N.V., Semichev E.V., Tskhai V.F. Current trends in the treatment of liver abscesses. Grekov's Bullitin of Surgery. 2018; 177 (6): 87–90. doi: 10.24884/0042-4625-2018-177-6-87-90 (In Russian)

20. Anand R.J., Ferrada P.A., Darwin P.E., Bochicchio G.V., Scalea T.M. Endoscopic retrograde cholangiopancreatography is an effective treatment for bile leak after severe liver trauma. J. Trauma. 2011; 71 (2): 480–485. doi: 10.1097/TA.0b013e3181efc270

21. Marcos-Ramírez E.R., Téllez-Aguilera A., Ramírez-Morín M.A., Treviño-Martínez M.I., Vásquez-Fernández F., Hernández-Guedea M.A., Muñóz-Maldonado G. Endoscopic retrograde cholangiopancreatography for treatment biliopleural fistulas. Cir. Cir. 2021; 89 (1): 89–96. doi: 10.24875/CIRU.20000055

22. Banerjee N., Rattan A., Priyadarshini P., Kumar S. Post-traumatic bronchobiliary fistula. BMJ Case Rep. 2019; 12 (4): e228294. doi: 10.1136/bcr-2018-228294

23. Botiraliev A.Sh., Stepanova Yu.A., Vishnevsky V.A., Zhao A.V. Post-Resection biliar complications. Journal of Experimental and Clinical Surgery. 2021; 14 (3): 228–236. doi: 10.18499/2070-478X-2021-14-3-228-236 (In Russian)