Massive Liver Trauma-Multidisciplinary Approach and Minimal Invasive Surgery can Salvage Patients

Abstract

Management of massive liver trauma (grades IV-VI) is associated with high morbidity and mortality. It can pose serious challenges to treating physician and requires multimodality interventions. For a successful outcome, timing of intervention is crucial. We report a case of grade V hepatic injury treated successfully with angioembolization, laparoscopic lavage, and endoscopic stenting during a time period from admission to discharge on the 24th day. Angioembolization was performed at admission after resuscitation as CT scan showed active extravasation in the arterial phase. Laparoscopic lavage and drainage was performed on the fifth day as abdominal inflammatory response failed to respond to medical management. There was biliary component of abdominal fluid noticed during laparoscopy, which manifested by postoperative localized biliary fistula; hence endoscopic stenting of the bile duct was performed on the seventh day. The patient recovered well with timely minimal invasive approach and was fine at 1 year follow-up.

Keywords: Angiographic embolization; Biliary fistula; Hepatic trauma; Laparoscopic lavage.

Fig. 1

CT scan showing blush of contrast

Fig. 2

Celiac angiography: coils in the right hepatic artery branches

Fig. 3

Day 5 CT scan: gross intra-abdominal fluid

Fig. 4

Intraoperative liver contusion

Fig. 5

CES: regenerating liver

Fig. 6

ERCP: bile leak from right posterior duct