Laparoscopic treatment of biliary peritonitis following nonoperative management of blunt liver trauma.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Marzano
Ettore
E
Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre Universitaires de Strasbourg, Avenue Molière, 67098 Strasbourg Cedex, France. patrick.pessaux@chru-strasbourg.fr.
Rosso
Edoardo
E
Oussoultzoglou
Elie
E
Collange
Olivier
O
Bachellier
Philippe
P
Pessaux
Patrick
P