Biliary leaks and fistulas are also a common complication after liver and biliary surgery. Leaks and fistulas may take origin from various procedures like bilio-digestive anastomoses, bile or cystic duct stumps or other intraoperative bile duct injury [9, 10]. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. Most bile leaks from the intra-hepatic biliary tree are transient and managed conservatively by drainage alone or by endoscopic biliary decompression. Minimally invasive percutaneous techniques for the management of biliary leaks and fistulas include percutaneous bile collection drainage, percutaneous trans-hepatic biliary drainage, biliary leak site embolisation sclerosis, ablation of a leaking biliary segment and treatment with a covered stent.
Pthc Collection 265
Biliary leaks are an abnormal passage or communication from the biliary system to another location, intra- or extra-hepatic, and most commonly follow gallbladder surgery but can result from ductal injury related to blunt or sharp trauma or iatrogenic injury (e.g. liver biopsy) [15]. The most commonly accepted definition of a bile leak requires the presence of bile discharge from an abdominal wound and/or drain, with a total bilirubin level of >5 mg/ml or three-times the serum level, intra-abdominal collections of bile confirmed by percutaneous aspiration or cholangiographic evidence of dye leaking from the opacified bile ducts [16]. Surgery for hydatid disease may also lead to internal biliary leaks, with a frequency between 4 % and 28 %, mainly when deeply located cysts and right lobe cysts are excised [17].
In the case of bile leaks and fistulas, ultrasound and CT may help in the detection of the localised collections of bile or bile lying free in the peritoneal cavity. CT scanning may be used in conjunction with intravenous cholangiography (CT-IVC) to produce axial and three-dimensional images [22]. This technique is very useful in the detection of stones and in the creation of virtual cholangiographic pictures and may be very valuable in defining sites of leaks as it has the functional dimension that conventional MRCP does not.
a Laceration and obstruction of common hepatic duct post laparoscopic cholecystectomy that led to biloma formation. b Percutaneous CT-guided drainage of the biloma. c Cholangiographic picture that confirms the communication of the collection with the biliary system. Surgical repair of the bile ducts followed
2ff7e9595c
コメント