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NESS 2006 Annual Meeting
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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.


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