Liver laceration with biloma

Case contributed by Dr Andrew Dixon

Presentation

High speed car accident.

Patient Data

Age: 35 years
Gender: Female

Day 1

CT

Complex right lobe of liver laceration without contrast blush (no active bleeding or pseudoaneurym) but with moderate hemoperitoneum in all four quadrants and sentinel clot. Right adrenal hemorrhage and right perirenal hematoma are also present. Bilateral rib fractures. Bilateral chest tubes with trace to small volume pneumothorax. Left lumbar transverse process fractures. Right sacral alar fracture. Right superior and inferior pubic rami fractures. No large extra-peritoenal pelvic hematoma. 

Day 7

CT

Follow-up CT 7 days post trauma laparotomy reveals fluid density (HU 0) distending portions of the right hepatic laceration with rounded morphology bulging the hepatic segment 6 capsule. The appearance is most in keeping with a post-traumatic biloma due to bile duct injury.  IVC filter in-situ. 

Case Discussion

Multi-trauma patient with a liver laceration complicated by the development of a traumatic biloma due to bile duct injury. This was managed conservatively and resolved. 

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