Screening and management of major bile leak after blunt liver trauma

A retrospective single center study

Kuo Ching Yuan, Yon Cheong Wong, Chih Yuan Fu, Chee Jen Chang, Shih Ching Kang, Yu Pao Hsu

Research output: Contribution to journalArticle

13 Citations (Scopus)

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 43.6μmol/L during admission.

Original languageEnglish
Article number26
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume22
Issue number1
DOIs
Publication statusPublished - Apr 15 2014
Externally publishedYes

Fingerprint

Bile
Liver
Wounds and Injuries
Cholangiography
Injury Severity Score
Arteries
Bilirubin
Torso
Trauma Centers
Taiwan
Registries
Length of Stay
Demography
Sensitivity and Specificity

Keywords

  • Bile leak
  • Blunt abdominal trauma
  • Blunt liver injury
  • Endoscopic retrograde cholangiography
  • Jaundice
  • Liver injury
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Screening and management of major bile leak after blunt liver trauma : A retrospective single center study. / Yuan, Kuo Ching; Wong, Yon Cheong; Fu, Chih Yuan; Chang, Chee Jen; Kang, Shih Ching; Hsu, Yu Pao.

In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol. 22, No. 1, 26, 15.04.2014.

Research output: Contribution to journalArticle

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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 43.6μmol/L during admission.",
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AU - Kang, Shih Ching

AU - Hsu, Yu Pao

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N2 - 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 43.6μmol/L during admission.

AB - 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 43.6μmol/L during admission.

KW - Bile leak

KW - Blunt abdominal trauma

KW - Blunt liver injury

KW - Endoscopic retrograde cholangiography

KW - Jaundice

KW - Liver injury

KW - Trauma

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