Traumatic liver and bile duct injuries

Case contributed by Dr Henry Knipe

Presentation

Crush injury.

Patient Data

Age: 25 years
Gender: Male

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 haemoperitoneum with haematocrit 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 haemoperitoneum, 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. 

Fluoroscopy

ERCP

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. 

PlayAdd to Share

Case information

rID: 49510
Case created: 24th Nov 2016
Last edited: 22nd Dec 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.