New England Surgical Society (NESS)
Search NESS
  Annual Meeting
  Annual Resident and Fellow Research Day
      Member Directory
      Members Only
  Scholars Foundation
  Job Board
  Journal of the American College of Surgeons
  Contact NESS

NESS 2006 Annual Meeting
Back to Scientific Program
Back to Annual Meeting

Biliary Complications Following Hepatic Trauma: The Importance of ERCP
Graciella Bauza, Elliot Servais, David Lichtenstein, Suresh Agarwal, Peter Burke, Erwin Hirsch
Boston University School of Medicine, Boston, MA

Objective: Develop and test an algorithm for utilizing ERCP in the evaluation and treatment of biliary complications following hepatic trauma.
Design: Case control
Setting: Urban, level 1 trauma center
Patients: Twenty-eight patients (ages 15-51, 79% male, average ISS 24.7) who underwent ERCP after hepatic trauma for biliary injuries from December 2000 to April 2006.
Interventions: Endoscopic retrograde cholangiopancreatography (ERCP) with stenting and/or sphincterotomy
Main Outcome Measures: Mechanism of injury, AAST liver injury grade, HIDA scan results, ERCP findings, bile leak outcomes, ERCP-related complications, and length of stay
Results: Over 65 months, 255 patients were admitted with major hepatic trauma (145 blunt and 80 penetrating injuries). Twenty-eight patients (12.4%; 13 blunt, 15 penetrating) underwent ERCP for biliary injury diagnosed by HIDA scan in 26 patients and by clinical exam alone in 2 patients. Average AAST liver injury grade was 3.25. Average time of bile injury diagnosis was hospital day 7. In 8 cases, leaks found to be “contained” on HIDA scan were extrahepatic on ERCP. All leaks resolved following ERCP and no patient required operative drainage. Eight patients had IR drainage of intra-abdominal biliary collections. There was one ERCP-related complication - moderate pancreatitis, which resolved with non-operative management. No deaths in the ERCP cohort and average LOS was 25.8 days.
Conclusions: ERCP is a safe and effective strategy for managing biliary complications following hepatic trauma. ERCP better distinguishes extra-hepatic biliary leaks than HIDA scan and eliminates the need for more invasive drainage procedures. An algorithm for hepatic trauma including ERCP decreases morbidity in this patient population.

Back to Scientific Program
Back to Annual Meeting

Copyright © 2020 New England Surgical Society. All Rights Reserved.
Read Privacy Policy.