Diagnosis and management of bile leaks after severe liver injury: A Trauma Association of Canada multicenter study

BACKGROUND Optimal management of bile leaks (BLs) after severe liver injury is unknown. Study objectives were to define current practices in diagnosis and management of BL to determine which patients may benefit from endoscopic retrograde cholangiopancreatography (ERCP). METHODS American Association for the Surgery of Trauma grade ≥III liver injuries from 10 North American trauma centers were included in this retrospective study (February 2011 to January 2021). Groups were defined as patients who developed BL versus those who did not. Subgroup analysis of BL patients was performed by management strategy. Bivariate analysis compared demographics, clinical/injury data, and outcomes. Receiver operating characteristic curves were performed to investigate the relationship between bilious drain output and ERCP. RESULTS A total of 2,225 patients with severe liver injury met the study criteria, with 108 BLs (5%). Bile leak patients had higher American Association for the Surgery of Trauma grade of liver injury (p 300 mL of daily output. Prospective multicenter examination will be required to validate these retrospective data. LEVEL OF EVIDENCE Therapeutic and Care Management; Level IV.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - Category: Orthopaedics Tags: TAC 2022 Source Type: research