Percutaneous Treatment of Iatrogenic and Traumatic Injury of the Biliary System

Abstract

Traumatic or iatrogenic bile duct injury (BDI) includes bile leaks, benign stenoses, and fistulae. These complications result in significant morbidity and mortality. This review will provide insight into the presentation, diagnosis, classification, and percutaneous management of BDI. Prompt diagnosis through non-invasive imaging and minimally invasive procedures is paramount to improved patient outcomes. Numerous classifications of BDI exist, although none are universally accepted. Percutaneous approaches to the management of BDI offer a minimally invasive alternative to traditional surgery. Bile leaks are primarily treated with drainage and decompression; however, adjunctive techniques such as embolization are also presented. Fistulae are routinely treated with embolization even though limited literature exists to provide a consensus treatment algorithm. Benign stenosis is primarily treated with balloon dilation with long-term biliary intubation while placement of bile duct stents is often reserved for patients with recurrent stricture. Iatrogenic or traumatic BDI typically requires a multidisciplinary team approach, although prompt diagnosis and advances in therapeutic approaches have improved patient outcomes.