Biloma and biliary fistula following hepatorraphy for liver trauma: incidence, natural history, and management.
From 1986-1992, more than 6250 patients were admitted to a Level I Trauma Center, with 175 patients requiring hepatorraphy. Eleven patients (6%) developed either a biloma (1), biliary fistula (2), or both (8 patients). Patients' ages ranged from 15-40 years with a mean Injury Severity Score of 23. Seven patients (64%) suffered penetrating injury and four (36%) were victims of blunt trauma. The right lobe was injured in 10 patients (91%), with one patient (9%) sustaining left lobe injury. All liver injuries were either grade 3 (seven patients, 64%) or grade 4 (four patients, 36%). No patient sustained extrahepatic biliary tract injury. Bilomas and fistulas were diagnosed 14-30 days post injury (mean 24 days) by CT and HIDA scans. All were managed by CT-guided percutaneous drainage. One patient also required percutaneous transhepatic cholangiography with biliary stent placement due to bile ascites. Fistulas persisted from 5-120 days (mean 44 days). No patient required further operative intervention and all fistulas closed spontaneously without complication.