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Laparoscopic treatment of biliary peritonitis following nonoperative management of blunt liver trauma

DOI: 10.1186/1749-7922-5-26

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Abstract:

A 28 years-old male was admitted in the Emergency Unit following a motor vehicle crash. CT-scan showed an isolated stade II hepatic injury at the level of the segment IV. Firstly a NOM was decided. Laparoscopic exploration was then performed at day 4 due to a biliary peritonitis. Intraoperative trans-cystic duct cholangiography showed a biliary leaks of left hepatic biliary tract, involving sectioral pedicle to segment III. Cholecystectomy, trans-cystic biliary drainage, application of surgical tissue sealing patch and abdominal drainage were performed. Postoperative outcome was uneventful, with fast patient recovery.Laparoscopy has gained a role as diagnostic and therapeutic means in treatment of complications following NOM of blunt liver trauma. This approach seems feasible and safety, with satisfactory postoperative outcome.Nowadays nonoperative management of blunt hepatic injuries is considered the treatment of choice in about 70% of cases. This attitude lead to appearance of otherwise unknown complications including bleeding, biliary, infectious and abdominal compartement syndrome. In selected cases, laparoscopy could be considered a valid option to treat these complications.Nonoperative management (NOM) of hemodynamically stable patients with blunt hepatic injuries is considered as the current standard of care [1,2]. Recent series reported that approximately 70% of patients with blunt liver injuries can be treated nonoperatively, with no hepatic-related mortality [3]. However, nonoperative treatment has been associated with several in-hospital complications, including bleeding, biliary, infectious and abdominal compartement syndrome. In this scenario, laparoscopy as gained a role as diagnostic and therapeutic means with favourable results [4,5]. Nevertheless, its application still remain under-proposed.A 28 years-old male was admitted in the Emergency Unit following a motor vehicle crash. The patient was hemodynamically stable (blood pressure = 110/70 mmHg; ca

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