J Acute Care Surg.  2021 Nov;11(3):137-140. 10.17479/jacs.2021.11.3.137.

An Unusual Recurrent Bile Leak Following High Grade Liver Trauma

Affiliations
  • 1Alfred Health, Department of General Surgery, Melbourne, Victoria, Australia
  • 2National Trauma Research Institute, Melbourne, Victoria, Australia

Abstract

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.

Keyword

bile; endoscopic retrograde cholangiopancreatography; laparotomy; liver; trauma; wounds
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