Biloma following hepatic artery embolisation (HAE) for major liver trauma at the alfred - is early endoscopic or surgical intervention required?

Abstract

Non-surgical management of blunt liver trauma contributed to reduced mortality from liver trauma. Hepatic artery embolisation (HAE) has become a key part of the treatment algorithm for treatment of hepatic trauma with arterial extravasation. However, significant complications can follow HAE. We aimed to identify the incidence of endoscopic or surgical intervention after HAE. We performed a 10 year retrospective review of a prospectively maintained database of patients undergoing HAE for severe liver trauma (AIS >3). Demographics, site of liver injury, vessel embolised and complications were recorded and analysed. There were 358 cases of severe liver trauma (AIS >3) in the study period. Thirty one (8.6%) patients underwent HAE (10 grade III, 19 grade IV and 2 grade V). There were no deaths in the patients undergoing HAE. The most common mechanism was blunt trauma (n=27/31; 87%) and segments V-VIII were more commonly injured (n=25/31; 81%). Fifty percent (11/22) of patients who underwent HAE with grade IV-V liver injuries developed a biloma that required either percutaneous or endoscopic drainage Overall, of 31 patients undergoing HAE, 5 underwent early hepatectomy for major hepatic necrosis following HAE and 8 underwent early ERCP and stenting to treat biloma formation. 5 patients also required percutaneous drainage. Severe liver trauma requiring HAE is associated with intrahepatic biliary complications. Further intervention is required in a significant proportion of these patients and represents a significant health care burden arising from HAE that should be anticipated and treated early.