Operative management of biliary peritonitis complicating blunt hepatic trauma using partial hepatectomy and trans-hepatic biliary stenting.

INTRODUCTION: Biliary peritonitis complicating blunt hepatic trauma is a rare but potentially lethal condition. PRESENTATION OF CASE: A 17-year old male patient who sustained a complex grade IV blunt hepatic trauma presented with severe haemorrhagic shock after an initial laparotomy in another hospital. An urgent exploratory laparotomy revealed a shattered posterior section of the right liver and suture haemostasis of the lacerated liver surface was performed. Postoperatively, the patient developed generalized biliary peritonitis and another laparotomy with peritoneal lavage and drainage was performed on postoperative day 12. However, ongoing manifestations of peritonitis and sepsis necessitated a third laparotomy 6 days later. This revealed ongoing biliary peritonitis due to major intra-hepatic bile duct injury. A partial hepatectomy with intra-operative trans-hepatic biliary stenting was undertaken. Postoperative recovery was uneventful and the biliary fistula healed completely by the end of the second postoperative week. DISCUSSION: Major intra-hepatic bile duct injury following blunt hepatic trauma is an extremely rare cause of biliary peritonitis.
CONCLUSION: The combination of partial hepatectomy with intra-operative trans-hepatic biliary stenting proved to be a safe and effective method for treatment of biliary peritonitis due to major intra-hepatic bile duct injury following blunt hepatic trauma when non-operative management fails.