Abstract
A 25-year-old male patient sustained complex blunt hepatic trauma after abdominal crush injury by an object heavier than 100 kg. He had liver laceration, pulmonary contusion and hemothorax. Exploratory laparotomy was performed, followed by urgent hepatorrhaphy. After 3 weeks, the patient presented with sharp pain and discomfort in the upper right quadrant and abdominal distension associated with intense nausea. An abdominal ultrasound (US) demonstrated voluminous liver cyst formation. Abdominal computed tomography (CT) was performed and showed voluminous intrahepatic loculated fluid collection (Figure 1). Magnetic resonance cholangiopancreatography (MRCP) was then performed (Figure 2) to exclude cystic lesion and to establish the actual location of the lesion; it demonstrated extra- and intrahepatic biliary tree injury (Figure 3). Abdominal drainage of the collection was performed by ultrasound-guided percutaneous drainage, collecting about 1,500 mL of bile, and confirmed the diagnosis of biloma. The procedure had no complications, and the patient was discharged with an abdominal tube draining biliary secretion, which was removed after 3 weeks. After two months, follow-up CT demonstrated the resolution of the case. The patient was then followed every two months for the following six months after the drainage procedure, with tomographic studies demonstrating no new biliary leak. Hence, he was finally discharged in good medical condition. Keywords: Biloma; biliary leak; liver trauma
Highlights
A 25-year-old male patient sustained complex blunt hepatic trauma after abdominal crush injury by an object heavier than 100 kg
Biloma is the collection of bile, encapsulated or not, outside the biliary tree, either inside or outside the liver
Posttraumatic intrahepatic biliary cysts, or bilomas, were first described in 1898 by Whipple, in a patient hit by a horse
Summary
Biloma is the collection of bile, encapsulated or not, outside the biliary tree, either inside or outside the liver. The gallbladder is the most common site of biliary injury in blunt trauma, followed by the extra- and intrahepatic biliary ducts, respectively. The detection of biliary tree injury during surgical treatment of blunt hepatic trauma is challenging. For a surgeon, a biloma is a disease to be considered, and a high level of suspicion is required during the follow-up of blunt hepatic trauma. A delayed diagnosis of biloma due to biliary tree injury usually results in increased morbidity. In this case using US, helps in the diagnosis and treatment. For this reason, percutaneous drainage has been proposed as first therapeutic option; the success rate of the procedure is 80%4. Long-term follow-up of these patients is necessary due to a possible new complication of the trauma of the biliary tract, which is ductal stenosis, with consequent recurrent cholangitis and hepatic cirrhosis[5]
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