Diagnosis and treatment of post-traumatic biliary leakage

OBJECTIVE: To improve the quality of management in biliary leakage following liver or bile tract injury. METHODS: All patients with liver and/or bile duct injuries from October 1987 to February 1998 inclusive were studied retrospectively in respects of their age, sex, type and mechanism of injury, the grade of liver trauma, treatment and subsequent complications. RESULTS: In 271 patients with hepatobiliary injuries, 14 (5.17%) developed a bile leak, which fell into 2 main types: Type I, injuries involving extrahepatic or first-order bile ducts (6 patients);Type II, injuries of more peripheral biliary radicles (8 patients). Most bile leakages in this series closed spontaneously in 7-14 days postoperatively. Intra-abdominal infection (28.57%) was a frequent complication which required active intervention. CONCLUSIONS: In the management of biliary leakage, it is important that (1) the leakage should be well localized; (2) adequate abdominal drainage plays a key role in controlling any type of biliary leakage; (3) decompression of the biliary tract favors the healing of injured biliary tree, especially in Type I leakage.