Biliary Leaks and Bilomas: Etiology, Diagnosis, and Management Techniques

Biliary leaks and bilomas are significant complications that arise more commonly from iatrogenic or traumatic bile duct injury. These are increasingly occurring primarily due to the growing number of laparoscopic cholecystectomies performed. Diagnosis can be challenging because of nonspecific patient symptoms, but early recognition and treatment is crucial for improving patient outcomes. Detection of biliary leaks involves a strong clinical suspicion and multimodal imaging studies, including magnetic resonance cholangiopancreatography, cholescintigraphy, endoscopic retrograde cholangiopancreatography, or percutaneous transhepatic cholangiography. Definitive treatment most often requires the endoscopic placement of biliary stents to decrease pressure in the biliary system and the placement of a percutaneous drain for drainage if a biloma is found. However, biliary leaks are heterogeneous in their severity and location, and some are refractory to the standard approach. In such cases, novel and minimally invasive techniques, rather than surgical procedures, have been described for the treatment of biliary leaks. Diagnosis and management require a multidisciplinary approach by diagnostic radiologists, interventional radiologists, gastroenterologists, and surgeons.