Blunt spleen and liver trauma complicated with biliary fistula: A case report

Abstract text (incl. references and figure legends)

We report a case of a 32-year-old male that was found hypotensive and unresponsive (Glasgow Coma Scale:7) by the emergency response team, after a motorcycle crash with a lamppost. The patient was intubated on site, initiated fluid resuscitation and tranexamic acid perfusion.

Upon hospital admission, the patient was in hypovolemic shock, due to intra-abdominal bleeding, confirmed by FAST Scan. The massive transfusion protocol was activated and the patient was taken to the operating room, to perform an emergency exploratory laparotomy.

The findings during surgery included large hemoperitoneum, right kidney laceration with retroperitoneal hematoma and grade IV spleen and liver injury, according to the AAST classification.

It was performed an emergency splenectomy, gauze-packing of the liver and hemoperitoneum evacuation. The abdomen was temporarily closed using an open abdomen negative pressure therapy system. The patient was then admitted to the intensive care unit after exclusion of other traumatic injuries.

A "second look" surgery was performed two days later, with removal of the liver packing, showing no signs of active bleeding. It was performed resection of the areas of devitalized liver tissue, with pedicled omentum hepatorrhaphy. An abdominal drainage tube was placed and the abdominal wall was closed.

The surgery complicated with a biliary fistula that was successfully managed with expectant treatment, without the need for surgery or endoscopic approach.

We presented a case of liver and spleen injury following blunt abdominal trauma requiring emergent surgical treatment to stabilize the patient, complicated with biliary fistula, an uncommon complication of blunt liver injury.

Coccolini, F., Coimbra, R., Ordonez, C. et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg 15,24(2020)

Coccolini, F., Montori, G., Catena, F. et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 12,40(2017)

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