Presentation
Crush injury.
Patient Data
Large laceration extending through liver segment four and one to the hilum. No opacification of the left portal vein before the confluence with the right portal vein, however, there is early opacification on the arterial phase proximally suggesting a traumatic arteriovenous fistula. Large volume hemoperitoneum with hematocrit effect. Large volume of free fluid in the lesser sac but no free gas.
The patient proceeded to a trauma laparotomy with operative findings of large hemoperitoneum, perforated stomach at the lesser sac, and large liver laceration with a ruptured caudate lobe. Two drains were left in, which subsequently drained a large volume of bile.
Liver laceration. Bile leak from the left hepatic duct branches, with likely transection at the confluence of segment 2 and 3 ducts. Surgical drain in the lesser sac.
ERCP performed demonstrating biliary leak in keeping with transection. Plastic stent left in the lower CBD and a sphincterotomy was performed.
Case Discussion
This is an example of a severe grade V liver laceration with associated bile duct injury. Bile duct injuries are rare, seen in ~0.1% of trauma admissions and are most commonly associated with blunt liver injury, especially true of intrahepatic duct injuries.