Abstract
BackgroundVarious minimally invasive therapies are important adjuncts to management of hepatic injuries. However, there is a certain subset of patients who will benefit from liver resection, but there are no reports in the literature on laparoscopic anatomical liver resection for the management of complications after blunt liver trauma.Case presentationA 20-year-old male was admitted to the Emergency Unit of a tertiary referral center following a car accident. The patient was hemodynamically stable, and a radiologic workup demonstrated an isolated grade 3 injury of the left hemiliver. Initially, a nonoperative management was indicated, but during days following the injury, a high-volume biliary fistula complicated the clinical course. Despite percutaneous drainage, the development of devastating consequences of biliary peritonitis was imminent. A pure laparoscopic anatomical liver resection was performed. Left lateral sectionectomy eliminated the source of bile leak, and the surgery was completed with abdominal cavity lavage. Postoperative outcome was uneventful, and the patient was discharged on day 9 after injury and day 4 after surgery returning to his normal activity.ConclusionsIn highly selected, hemodynamically stable patients with no other life-threatening concomitant injuries, laparoscopic liver resection in elective setting is feasible and safe for the management of complications after complex blunt trauma of the left liver. Extensive experience with hepatic surgery is needed, and surgeons should understand the increased risk they assume by taking on more complex surgical techniques.
Highlights
Various minimally invasive therapies are important adjuncts to management of hepatic injuries
Nonoperative management (NOM) of blunt liver trauma (BLT) has become the standard of care for hemodynamically stable patients
There is a certain subset of patients with BLT who will benefit from a resectional therapy
Summary
There are several other adjunctive therapies available; a subset of patients might benefit from a definitive resectional therapy. In this case, the resection of the injured portion of the left liver eliminated the devitalized tissue and controlled the bile leak. VP and BI participated in the surgery, gathered the patient’s data, and contributed for the review of the literature and editing of the manuscript. Consent for publication Written informed consent has been obtained from the patient for publication of this case report and any accompanying images. Author details 1Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia. Author details 1Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia. 2Department of Radiology, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
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