Blunt liver trauma and bile leakage

Abstract text (incl. references and figure legends)

CASE HISTORY: A 55-year-old male presented with acute abdominal pain at the ER following a work accident. He fell from a 3m height and injured his right hemithorax. Patient was haemodynamically unstable. BP=70/40 mmHg, HR=120 bpm, SpO2=96%, GCS=14/15.

CLINICAL FINDINGS: Abdominal examination revealed tenderness in the right upper quadrant. No other significant injuries identified.

INGESTIGATION/RESULTS: U/S FAST was positive for free intraperitoneal fluid collection. Following resuscitation, CT scan showed grade IV-V multiple liver lacerations at segments V-VI-VII-VIII with extravasation of contrast in the venous and delayed phases.

DIAGNOSIS: The diagnosis set was blunt liver trauma.

THERAPY AND PROGRESSIONS: The patient underwent urgent laparotomy which showed grade IV-V lacerations in the right posterior liver lobe. Liver packing was initially performed. The patient underwent three subsequent urgent laparotomies during the first 24 hours. Finally, right hepatic artery ligation took place. The patient was admitted in the ICU. The second look operation included liver packing removal and cholecystectomy. On the 5th post-operative day, bile leakage was identified. On the 34th post-operative day the patient underwent ERCP and CBD stenting. He was discharged from the hospital on the 44th post-operative day completely recovered.

COMMENTS: The patient initially presented a bilious drainage of 200-300 ml/24h. Following ERCP, the patient was discharged with a bilious drainage of less than 20 ml/24h.

REFERENCES:

Afifi I, Abayazeed S, El-Menyar A, Abdelrahman H, Peralta R, Al-Thani H. Blunt liver trauma: a descriptive analysis from a level I trauma center. BMC Surg. 2018 Dec;18(1):42 Oo J, Smith M, Ban EJ, Clements W, Tagkalidis P, Fitzgerald M, et al. Management of bile leak following blunt liver injury: a proposed guideline. ANZ Journal of Surgery. 2021 Jun;91(6):1164–9

FIGURE 1: Pre-operation CT scan

FIGURE 2: ERCP pre-stenting

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