Recent series reported that approximately
70% of patients with blunt liver injuries selleck screening library can be treated nonoperatively, with no hepatic-related mortality . 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. Case report 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; cardiac frequency = 95/min) and conscious (Glasgow coma score = 15). The clinical examination showed an abdominal distension and diffuse pain. FAST echography revealed a moderate peritoneal effusion. Total-body CT scan was performed, which showed an isolated stade II  hepatic injury at the level of the segment IV (fig 1). Haemoglobin at admission was 12.3 g/dl (normal range 13-18 g/dl) and remained stable at 11.7 g/dl 6
hours after. NOM was decided. Four days after the admission, due to the appearance of an inflammatory response on blood test – CRP 101 mg/dl (normal <4 mg/dl) white cells 15.6 10*9/L (normal range 4.10-10.50 10*9/L) - and the persistence of abdominal pain, an hepatic MR with TESLASCAN (fig 2) was performed which showed a biliary leaks originating from left liver. Laparoscopic exploration revealed an intense biliary peritonitis. Liquid sample was performed. Janus kinase (JAK) Hepatic exploration confirmed the Epoxomicin order presence of a liver fracture of segment IV without signs of active bleeding. Cholecystectomy followed by a trans-cystic cholangiography (fig 3) showed a biliary leaks of left hepatic biliary tract,
involving sectioral pedicle to segment III. Hemostatic and tissue sealing (Nycomed TachoSil®) surgical patch was applied on liver injury, in order to minimized biliary spillage. Two intra-abdominal and a trans-cystic biliary drains were inserted in view to drain abdominal cavity and biliary tree, respectively (Additional file 1). Postoperative outcome was uneventful and patient was discharged at postoperative day 18th. Figure 1 CT-scan at arrival. Figure 2 Preoperative Teslascan. Figure 3 Intraoperative cholangiography. Conclusions Liver related morbidity after NOM of blunt liver injury is reported within 12% rate in most series [2, 5, 7]. Hepatic related complications usually consisted in: bleeding, biliary, hepatic abscess or necrosis, and development of abdominal compartment syndrome. Concerning biliary complications, bile duct injury, development of bilioma and biliary GW786034 manufacturer peritonitis were mostly described [7, 8]. Multimodality management consisting of, radiological drainage, endoscopic stenting and surgery is frequently performed.