Management of Traumatic Liver and Bile Duct Laceration

Tiwari, Charu; Shah, Hemanshi; Waghmare, Mukta; Khedkar, Kiran; Dwivedi, Pankaj

doi:10.5005/jp-journals-10018-1247

Cited by 9 publications

(6 citation statements)

References 17 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared with the surgical management, endoscopic management with ERCP and stenting is more popular and success rates are as high as 90%–100%. 2 As the patient recovered remarkably with ERCP and stenting, our patient did not require surgical management, which is preserved for large BPF or following failure of conservative and endoscopic management.…”

Section: Discussionmentioning

confidence: 71%

“…1 These bile leaks can range from simple intraparenchymal or extraparenchymal bile leaks to more complex biliopleural fistula (BPF) formation. 2 BPF can give rise to cholethorax, an even rarer but wellknown complication where a bilious effusion is seen in the pleural cavity. 3 Bile in the pleural cavity can be damaging to the lungs and pleura due to the corrosive nature of bile and may further worsen the condition of the patient with already compromised physiology due to the initial trauma.…”

Section: Introductionmentioning

confidence: 99%

“… 1 The incidence is more in high-grade liver injuries. 2 Direct trauma, secondary rupture of subcapsular hematoma and bile duct ischemia can give rise to bile leaks. 1 These bile leaks can range from simple intraparenchymal or extraparenchymal bile leaks to more complex biliopleural fistula (BPF) formation.…”

Section: Introductionmentioning

confidence: 99%

“… 1 These bile leaks can range from simple intraparenchymal or extraparenchymal bile leaks to more complex biliopleural fistula (BPF) formation. 2 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Nonoperative management of grade IV liver laceration following blunt abdominal trauma complicated with delayed bilioplueral fistula

Yapa,

Prashanthan,

Mahanama

et al. 2023

SAGE Open Medical Case Reports

View full text Add to dashboard Cite

The incidence of bile leaks following blunt liver trauma ranges from 0.5% to 21%. Bile leaks could give rise to biliopleural fistula, which can end up causing cholethorax, where a bilious effusion is seen in the pleural cavity. Early recognition of this condition is essential for favorable outcome. We report an unusual case of delayed biliopleural fistula causing cholethorax in a 30-year-old male, presented following blunt abdominal trauma following a motor vehicle collision. Abdominal examination revealed tender right upper quadrant. He was haemodynamically stable following initial resuscitation. Computed tomography of the abdomen revealed American Association for the Surgery of Trauma grade IV liver laceration without active extravasation of contrast, causing a moderate haemoperitoneum. Decision was made to manage the liver injury conservatively. Repeat imaging performed on day 11 due to progressive abdominal distension revealed bilateral pleural effusions and increased amount of abdominal free fluid. Bilateral intercostal tubes and an ultrasound-guided pigtail catheter was inserted to the abdomen. The right-sided intercostal(IC) tube drainage found to be bilious, along with a bilious drainage through the pigtail catheter placed on the peritoneal cavity. Due to persistently high drain output, an endoscopic retrograde cholangiopancreatography performed revealed a contrast leakage at cystic duct. Sphincterotomy was performed and a biliary stent was placed. Patient completely recovered following decompression of biliary system. The unusual presentation of biliopleural fistula requires a good clinical acumen for early diagnosis. Timely endoscopic and interventional radiological management for biliary decompression and drainage are required for a successful outcome.

show abstract

Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 1 These bile leaks can range from simple intraparenchymal or extraparenchymal bile leaks to more complex biliopleural fistula (BPF) formation. 2 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nonoperative management of grade IV liver laceration following blunt abdominal trauma complicated with delayed bilioplueral fistula

Yapa,

Prashanthan,

Mahanama

et al. 2023

SAGE Open Medical Case Reports

View full text Add to dashboard Cite

show abstract

“…The incidence of biliary complications after blunt hepatic trauma has been reported to be 2.8–7.4% [ 25 ]. In addition to high-grade injury, centrally located liver injuries and early transcatheter arterial embolization are significant risk factors for major bile duct injury [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Damage control surgery for grade IV blunt hepatic injury with multiple organ damage in a child: a case report

et al. 2021

View full text Add to dashboard Cite

Background Intra-abdominal hemorrhage caused by blunt hepatic injury is a major cause of morbidity and mortality in patients with abdominal trauma. Some of these patients require laparotomy, and rapid decision-making and life-saving surgery are essential. Damage control (DC) surgery is useful for treating children in critical situations. We performed this technique to treat an 8-year-old boy with grade IV blunt hepatic injury and multiple organ damage. This is the first report of the use of the ABTHERA Open Abdomen Negative Pressure Therapy System (KCI, now part of 3 M Company, San Antonio, TX, USA) for DC surgery to rescue a patient without neurological sequelae. Case presentation An 8-year-old boy was brought to the emergency department of our hospital after being run over by a motor vehicle. He had grade IV blunt hepatic injury, thyroid injury, and bilateral hemopneumothorax. Although he was hemodynamically stable, the patient’s altered level of consciousness, the presence of a sign of peritoneal irritation, and suspicion of intestinal injury led us to perform exploratory laparotomy. As part of a DC strategy, we performed gauze packing to control hemorrhage from the liver and covered the abdomen with an ABTHERA Open Abdomen Negative Pressure Therapy System to improve the patient’s general condition. Eighteen days after admission, the patient was diagnosed with a biliary fistula, which improved with percutaneous and external drainage. He had no neurological sequelae and was discharged 102 days after injury. Conclusion The DC strategy was effective in children with severe blunt hepatic injury. We opted to perform DC surgery because children have less hemodynamic reserve than adults, and we believe that using this strategy before the appearance of trauma triad of death could save lives and improve outcomes. During conservative management, it is important to adopt a multistage, flexible approach to achieve a good outcome.

show abstract