POSTTRAUMATIC BILE FISTULAS

Bile leakage after liver injury has been reported to be a complication associated with significant mortality. In a prospective study of 306 patients with liver injuries 13 (4%) developed a bile leak. There appear to be two groups of patients, those with a major bile duct injury (three patients) and those with a more peripheral injury (ten patients). Bile leaks may present either as bile peritonitis (six patients) or as a bile leak through a drain site (seven patients). All but one bile leak closed spontaneously at a median of 33 days (range, 3-110 days). There was no mortality but patients incurred a median of four complications each (range, 1-5). This may reflect the severity of the initial injury rather than the bile leak. Respiratory failure and/or infection and sepsis were the most common complications whilst abnormalities of liver function, although common, were seldom of clinical significance.