Biloma and biliary fistula associated with hepatorrhaphy for liver injury

To review our experience in managing post-hepatorrhaphy complications in liver trauma.

During the period of 1986-1994, 6250 trauma patients were admitted to the Accident & Emergency Unit of the University Hospital Kuala Lumpur. The medical records were reviewed. There were 175 patients with liver trauma requiring hepatorrhaphy. The major post-operative complications (biloma and biliary fistula) were noted. We reviewed and discussed the various management of these biliary complications.

Eleven patients developed either a biloma, biliary fistula or both. Patients age ranged from 15 to 40 years with a mean ISS of 23. Seven patients suffered penetrating injury and 4 were victims of blunt trauma. The right lobe was injured in 10 patients, with 1 patient sustaining left lobe injury. All liver injuries were either grade 3 (7 patients) or grade 4 (4 patients). No patient sustained extrahepatic biliary tract injury. Biloma and fistulas were diagnosed 14-30 days post-injury (mean 24 days) by CT or HIDA scans. All were managed by CT-guided percutaneous drainage. One patient also required percutaneous transhepatic cholangiography with biliary stent placement due to bile-stained ascites. Fistulas persisted from 5-120 days (mean 44 days). No patient required further operative intervention all fistula closed spontaneously without complication.

Uncomplicated biliary fistula post-hepatectomy for liver trauma can be treated with percutaneous drainage.