title: Delayed laparoscopy facilitates the management of biliary peritonitis in patients with complex liver injuries.
abstract: BACKGROUND
  Nonoperative management is now regarded as the best alternative for the treatment of patients with complex blunt liver injuries. However, some patients still require surgical treatment for complications that were formerly managed with laparotomy and a combination of image-guided studies.
  
  
  METHODS
  We reviewed the medical records of 15 patients who had complex blunt liver injuries that were managed nonoperatively and in which biliary peritonitis developed.
  
  
  RESULTS
  Delayed laparoscopy was performed 2-9 days after admission in patients with extensive liver injuries. All 15 patients had developed local signs of peritonitis or a systemic inflammatory response. Laparoscopy was indicated to drain a large retained hemoperitoneum (eight patients), bile peritonitis (four patients), or an infected perihepatic collection (three patients). Laparoscopy was successful in all patients, and there was no need for further interventions.
  
  
  CONCLUSIONS
  The data indicate that as more patients with complex liver injuries are treated nonoperatively and the criteria for nonoperative management continue to expand, more patients will need some type of interventional procedure to treat complications that historically were managed by laparotomy. At this point, laparoscopy is an excellent alternative that should become part of the armamentarium of the trauma surgeons who treat these patients.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, and the Trauma Program in Surgery at University of Louisville Hospital, Louisville, KY 40292, USA. e0carr1@gwise.louisville.edu
authors.forename: E H
authors.initials: EH
authors.lastname: Carrillo
authors.forename: D N
authors.initials: DN
authors.lastname: Reed
authors.forename: L
authors.initials: L
authors.lastname: Gordon
authors.forename: D A
authors.initials: DA
authors.lastname: Spain
authors.forename: J D
authors.initials: JD
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000328:Adult; D001646:Bile; D005260:Female; D006465:Hemoperitoneum / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000601:surgery