Delayed bile leak in a patient with grade IV blunt liver trauma: A case report and review of the literature.
BACKGROUND
Delayed bile leak following blunt liver trauma is not common.


METHODS
We presented a case report and literature review of delayed bile leak in a young male patient who presented with grade IV blunt liver injury following a motor vehicle collision; he was a restrained driver who hit a fixed object. Physical examination was unremarkable except for revelaed tachycardia, right upper quadrant abdominal tenderness, and open left knee fracture. A diagnosis of grade IV multiple liver lacerations with large hemo-peritoneum was made and urgent exploratory laparotomy was performed. The patient developed a biloma collection post- operatively. He underwent endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct stenting. His recovery was uneventful, and he was discharged home after 1 month.


CONCLUSIONS
This is a rare case with no intra or extra hepatic biliary radicle injury seen on magnetic resonance cholangiopancreatography (MRCP) and no evidence of leak by ERCP. A review of the literature to highlight the incidence of delayed bile leak revealed only few reported cases.


CONCLUSIONS
Our findings demonstrate the need for prompt diagnosis and treatment of delayed bile leak in blunt liver injuries. When these principles are followed, a successful outcome is possible.
Department of surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. Electronic address: ammar_alhassani@yahoo.com.
Ammar
A
Al-Hassani
Department of Surgery, HGH, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
Gaby
G
Jabbour
Department of surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
Mohammad
M
ElLabib
Department of surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
Ahad
A
Kanbar
Department of Surgery, HGH, Doha, Qatar; Clinical Research, Trauma Surgery, HGH, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
Ayman
A
El-Menyar
Department of surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
Hassan
H
Al-Thani
Bile leak; Biloma; Blunt trauma; ERCP; Liver; MRCP