Surgical Treatment of Traumatic Liver Injury with Development of Biloma, Destructive Cholecystitis and Pseudoaneurysm: a Clinical Case

Abstract

Introduction. Traumatic liver injury is associated with the danger of developing various insidious complications, with some of them appearing immediately and others — eventually against a background of apparent clinical recovery. Modern sophisticated methods enable the character and localization of liver complications to be accurately revealed and those complications to be stopped by means of minimally invasive techniques. Materials and methods. A clinical case of the traumatic hepatic rupture caused by a fall from height and the subsequent development of successive complications, which, except for the primary surgery — suturing of the liver rupture through laparotomy — were stopped by minimally invasive techniques. Results and discussion. All complications that occurred and were subsequently treated have been divided into seven stages. Stage 1: rapid transfer of the patient to a multidisciplinary hospital. Stage 2: diagnostic laparoscopy followed by laparotomy and suturing of the liver rupture. Stage 3: puncture of the infected biloma. Stage 4: minilaparotomy cholecystectomy. Stage 5: antegrade percutaneous transhepatic drainage of the bile ducts. Stage 6: angiography of the hepatic artery and its branches. Stage 7: endovascular embolization of the pseudoaneurysm cavity. Conclusion. The authors presented the clinical case in order to demonstrate the feasibility and proper application of minimally invasive techniques to manage various complications of liver injury, avoid resection, save life, and preserve quality of life.