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Screening and management of major bile leak after blunt liver trauma: a retrospective single center study.

Yuan KC, Wong YC, Fu CY, Chang CJ, Kang SC, Hsu YP - Scand J Trauma Resusc Emerg Med (2014)

Bottom Line: Major bile leak occurred in 14 (4.9%) patients.A bilirubin level greater than 43.6 μmol/L provides a sensitivity of 100% and specificity of 85.1% for predicting major bile leak.ERC should be arranged early if the patient has risk factors and their plasma bilirubin level is greater than 43.6 μmol/L during admission.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, No,5, Fusing St, Gueishan Township Taoyuan County 333, Taiwan. bifida@ms4.hinet.net.

ABSTRACT

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 μmol/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 μmol/L during admission.

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Different locations of liver injury.
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Figure 1: Different locations of liver injury.

Mentions: In addition to the AAST grading for liver injury, we further divided liver injuries into central (involving segments 4, 5, or 8), peripheral (involving segments 2, 3, 6, or 7), or mixed (involving both central and peripheral segments) based on abdominal CT (Figure 1).


Screening and management of major bile leak after blunt liver trauma: a retrospective single center study.

Yuan KC, Wong YC, Fu CY, Chang CJ, Kang SC, Hsu YP - Scand J Trauma Resusc Emerg Med (2014)

Different locations of liver injury.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4012546&req=5

Figure 1: Different locations of liver injury.
Mentions: In addition to the AAST grading for liver injury, we further divided liver injuries into central (involving segments 4, 5, or 8), peripheral (involving segments 2, 3, 6, or 7), or mixed (involving both central and peripheral segments) based on abdominal CT (Figure 1).

Bottom Line: Major bile leak occurred in 14 (4.9%) patients.A bilirubin level greater than 43.6 μmol/L provides a sensitivity of 100% and specificity of 85.1% for predicting major bile leak.ERC should be arranged early if the patient has risk factors and their plasma bilirubin level is greater than 43.6 μmol/L during admission.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, No,5, Fusing St, Gueishan Township Taoyuan County 333, Taiwan. bifida@ms4.hinet.net.

ABSTRACT

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 μmol/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 μmol/L during admission.

Show MeSH
Related in: MedlinePlus