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Vascular and Interventional Radiology

E1200. Percutaneous management of intra and extra-hepatic biliary leakage: Alternatives to bile diversion.

Abdel Aal A,  Saddekni S,  Oser R,  Ursic E,  Moawad S. Universsity of Alabama at Birmingham (UAB), Birmingham, Alabama

Address correspondence to A. Abdel-Aal (akamel66@hotmail.com)

Background Information: Biliary leaks and fistulas are common complications following liver and biliary surgery. Biliary leaks are an abnormal passage or communication from the biliary system to intrahepatic or extrahepatic location. The accepted definition of a biliary leak requires the presence of biliary discharge from an abdominal wound or drain, with a total bilirubin level of the discharge of > 5 mg/mL or three times the serum level. Biliary leaks can occur at biliary-digestive anastomoses or other intraoperative bile duct injury. The incidence mainly depends on the type of surgery done, ranging from 0.2–0.3% after cholecystectomy and up to 30% after liver resection. The exhibit provides a review on anatomy, pathophysiology, diagnosis, and imaging findings of biliary leak. Finally, the interventional techniques used for the management of biliary leak is discussed.

Educational Goals/Teaching Points: We review the different classifications of biliary leaks and fistulas, describe the presenting symptoms and signs, highlight the role of different imaging modalities in the diagnosis of intrahepatic and extrahepatic biliary leakage and fistulas, demonstrate different percutaneous techniques for management of bile leaks, emphasize the percutaneous embolization of biliary leak and fistulas using different embolic materials, and outline the technique-related outcomes and the potential complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: The presentation is supported with multiple cases from our institution. We present the causes as well as the clinical presentation and radiologic findings (ultrasound, CT, and MRI) of these cases. A discussion of the details of percutaneous management technique and the outcomes is provided.

Conclusion: Several percutaneous interventional techniques can be used in the management of bile leaks. Apart from the standard biliary diversion procedures, embolization of the intrahepatic or extrahepatic leaking ducts can be attempted.