ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY IN THE NONSURGICAL MANAGEMENT OF BLUNT LIVER-INJURY

Injury to the intrahepatic bile duct has not been routinely examined in patients with blunt liver injury, despite the risk of formation of a biloma and hemobilia. In this study we examined the role of endoscopic retrograde cholangiography (ERC) in the evaluation of blunt liver injuries. Sixty-four of 106 (60.3%) patients with blunt hepatic injuries, admitted from April 1986 through March 1992, were managed nonsurgically; ERC was performed in conjunction with computed tomographic (CT) scanning to rule out injury to the bile duct in 28 patients. Injury to the bile duct was detected in six patients (21.4%), five of whom developed a biloma. Patients with hepatic parenchymal injuries that were observed on the CT scans were at greatest risk for injury to the intrahepatic bile duct, and our data suggested that the incidence of injury to the intrahepatic bile duct after blunt hepatic trauma is higher than previously reported. Patients with serious hepatic parenchymal injuries who are candidates for nonsurgical management should be considered for ERC to exclude the possibility of injury to the bile duct.