J Korean Soc Traumatol.  2014 Sep;27(3):89-93. 10.0000/jti.2014.27.3.89.

Management of Bile Leaks from Bilateral Intrahepatic Ducts after Blunt Trauma

• Kim DH
• Choi S
• Go SJ

• KMID: 2224106
• DOI: http://doi.org/10.0000/jti.2014.27.3.89

Abstract

Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.

Keyword

Bile leak; High-grade; Blunt liver trauma

MeSH Terms

Adult
Bile*
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct
Drainage
Follow-Up Studies
Heparin, Low-Molecular-Weight
Humans
Laparotomy
Liver
Liver Abscess
Peritonitis
Stents
Thrombosis
Vena Cava, Inferior
Rivaroxaban
Heparin, Low-Molecular-Weight