Elimination of bile leakage in liver injuries

Abstract

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.