INTRODUCTION: Nonoperative management (NOM) of hemodynamically stable patients with blunt hepatic injuries is considered the current standard of care. However, it is associated with several in-hospital complications. In selected cases laparoscopy could be proposed as diagnostic and therapeutic means. CASE REPORT: 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. CONCLUSION: 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.
INTRODUCTION: Nonoperative management (NOM) of hemodynamically stable patients with blunt hepatic injuries is considered the current standard of care. However, it is associated with several in-hospital complications. In selected cases laparoscopy could be proposed as diagnostic and therapeutic means. CASE REPORT: 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. CONCLUSION: 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.
Authors: Rosemary A Kozar; Frederick A Moore; C Clay Cothren; Ernest E Moore; Matthew Sena; Eileen M Bulger; Charles C Miller; Brian Eastridge; Eric Acheson; Susan I Brundage; Monika Tataria; Mary McCarthy; John B Holcomb Journal: Arch Surg Date: 2006-05
Authors: Rosemary A Kozar; John B Moore; Sarah E Niles; John B Holcomb; Ernest E Moore; C Clay Cothren; Elizabeth Hartwell; Frederick A Moore Journal: J Trauma Date: 2005-11
Authors: Ashley Britton Christmas; Ashley K Wilson; Benjamin Manning; Glen A Franklin; Frank B Miller; J David Richardson; Jorge L Rodriguez Journal: Surgery Date: 2005-10 Impact factor: 3.982