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

• Jones ME
• Ban EJ
• Pilgrim CHC

• KMID: 2522758
• DOI: http://doi.org/10.17479/jacs.2021.11.3.137

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