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Journal of Trauma and Injury 2014;27(3):89-93.
Management of Bile Leaks from Bilateral Intrahepatic Ducts after Blunt Trauma
Dong Hun Kim, Seokho Choi, Seung Je Go
1Trauma Center, Department of Surgery, Dankook University Hospital, Cheonan, Korea. gsmdchoish69@hanmail.net
2Department of Surgery, Eulji University Hospital, Daejeon, Korea.
둔상성 외상 후 양측 간내 담관에서 담즙 누출의 치료 사례 1례
김동훈, 최석호, 고승제1
단국대학교병원 외과 권역외상센터, 1을지대학교병원 외과
Received: 22 July 2014   • Revised: 17 August 2014   • Accepted: 21 August 2014
Abstract
Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.
Key Words: Bile leak; High-grade; Blunt liver trauma


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