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Complications of blunt liver trauma in polytraumatized patient ; case report

Authors want to describe complications of liver rupture in polytraumatized patient injured in a car accident. Male patient, 22 years old, was admitted to the emergency department with clinical signs of hypovolemic shock and right hip fracture. Conventional radiograms depicted multifragmentar fracture of the right acetabulum with femoral head luxation while blood tests revealed anaemia. CT assay showed stellate laceration of the liver parenchyma close to falciform ligament, right acetabulum and right femoral head fracture. During the first operation, liver laceration was treated with haemostatic material. Right acetabulum fracture was treated with osteosynthesis after haemodynamic stabilisation of the patient. Early recovery got complicated by massive production of free intraperitoneal fluid. Intrahepatal bile duct lesion was suspected. ERCP depicted rupture of VII liver segment bile duct and stenosis of the right main bile duct. Endobiliary stent was placed and intraabdominal bile leak and production of free intraperitoneal fluid decreased. Three days after bile duct intervention, patient developed high temperature and colicky abdominal pain. During relaparotomy, multifocal intraabdominal abscesses were found. Postoperative recovery was prolonged by the development of the pleural effusion on the basis of the left hemithorax. The patient was discharged from hospital on 79th day after trauma.

blunt abdominal trauma ; bile duct injury ; ERCP ; hemidiapragm rupture ; thrombocytosis

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