Biliary Stents are Associated with Increased Risk of Liver Abscess after Traumatic Liver Injury

Authors:
Anna Huang Perez, Henry Olivera Perez, Andrea Gochi, Adam Gutierrez, Genna Beattie, Naveen Balan, Lucas Thornblade, Gregory Victorino, April Mendoza

Body of Abstract:
Background

Liver abscess is a rare but highly morbid complication of traumatic liver injury. Many patients who develop a liver abscess have previously undergone biliary instrumentation leading to colonization of the biliary tract. We hypothesized that the use of biliary stents will be associated with greater risk of liver abscess after traumatic injury independent of surgical or angiographic intervention. We also sought to determine other risk factors for liver abscess after traumatic injury.

Methods

A retrospective review of adult patients presenting to a single level 1 trauma center with an American Association for the Surgery of Trauma (AAST) grade 3 or higher liver injury between 2017— 2025 was performed. Patient characteristics and outcomes were collected from the electronic medical record. Univariable and multivariable analyses identified risk factors and predictors of liver abscess.

Results

Two hundred and eighteen patients met inclusion criteria, of which 160 (73%) were male and 121 (56%) presented after blunt trauma. The median age was 31 years. Eighty-four patients (39%) underwent laparotomy, 28 (13%) underwent hepatic angioembolization, 16 (7%) underwent both interventions, and 122 (56%) did not undergo either intervention. Twenty-four patients (11%) developed a bile leak and 15 (7%) underwent common bile duct (CBD) stent placement. Sixteen patients (7%) developed a liver abscess and were treated with antibiotics for a median of 14 days post abscess diagnosis. Among the 12 patients who underwent either percutaneous or surgical drainage, Enterococcus faecalis was the most common organism that speciated (n=3).

On univariate analysis, risk factors for liver abscess were penetrating trauma (14% abscess rate in penetrating patients vs 2% abscess rate in blunt patients, p<0.001), bile leak (46% vs 3%, p<0.001), CBD stent (67% vs 3%, p<0.001), angioembolization (18% vs 6%, p=0.04), and laparotomy (18% vs 1%, p<0.001). In this sample, grade of liver injury, Injury Severity Score, and 24-hour packed red blood cell transfusions were similar between abscess and non-abscess patients. On multivariate analysis, CBD stent placement (OR 22, p=0.01) and laparotomy (OR 13, p=0.03) were independently associated with liver abscess. Conclusions These findings suggest that CBD stenting is associated with liver abscess after traumatic liver injury independent of other risk factors such as bile leak and angioembolization. Further studies may be warranted to investigate the effect of periprocedural antibiotics on the risk of liver abscess in patients who undergo biliary stenting after traumatic liver injury.