Surgical Treatment of Traumatic Liver Injury with Development of Biloma, Destructive Cholecystitis and Pseudoaneurysm: a Clinical Case

   Introduction. Traumatic liver injury is associated with the danger of developing various insidious complications, with some of them appearing immediately and others — eventually against a background of apparent clinical recovery. Modern sophisticated methods enable the character and localization of liver complications to be accurately revealed and those complications to be stopped by means of minimally invasive techniques.

   Materials and methods. A clinical case of the traumatic hepatic rupture caused by a fall from height and the subsequent development of successive complications, which, except for the primary surgery — suturing of the liver rupture through laparotomy — were stopped by minimally invasive techniques.

   Results and discussion. All complications that occurred and were subsequently treated have been divided into seven stages. Stage 1: rapid transfer of the patient to a multidisciplinary hospital. Stage 2: diagnostic laparoscopy followed by laparotomy and suturing of the liver rupture. Stage 3: puncture of the infected biloma. Stage 4: minilaparotomy cholecystectomy. Stage 5: antegrade percutaneous transhepatic drainage of the bile ducts. Stage 6: angiography of the hepatic artery and its branches. Stage 7: endovascular embolization of the pseudoaneurysm cavity.

   Conclusion. The authors presented the clinical case in order to demonstrate the feasibility and proper application of minimally invasive techniques to manage various complications of liver injury, avoid resection, save life, and preserve quality of life.

1. Voynovskiy A. E., Novikov G. A., Semenenko I. A., Kuptsov A. S. Use of innovative technologies in the treatment of patients with severe concomitant injury with liver damage: clinical observation. Meditsina katastrof = Disaster Medicine. 2021; 4: 61–3 (In Russ.). DOI: 10.33266/2070-1004-2021-4-61-63.

2. Evtikhov A. V., Lyubivyy E. D., Kim V. L. Treatment of severe liver trauma. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N. I. Pirogova. 2020; 7: 89–92 (In Russ.). DOI: 10.17116/hirurgia202007189

3. Sigua B. V., Zemlyanoy V. P., Dyukov A. K. Closed abdominal injury with liver damage. Grekov’s Bulletin of Surgery. 2015; 174 (1): 9–15 (In Russ.). DOI: 10.24884/0042-4625-2015-174-1-9-15

4. Shapkin Yu. G., Chalyk Yu. V., Stekolnikov N. Yu., Gusev K. A. Perihepatic paking as the first stage of damage control strategy (review). Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2017; 22 (4): 89–95 (In Russ.). DOI: 10.16931/1995-5464.2017489-95

5. Suda A. J., Fritsch G. Traumatic pancreas, kidney, liver, spleen, gastric and diaphragma rupture with enterothorax aft er blunt trauma caused by falling in an adolescent: a case report. Arch Orthop Trauma Surg. 2023 Apr 8: 1–9. DOI: 10.1007/s00402-023-04865-3

6. Podoluzhny V. I., Radionov I. A., Pelz V. A., Startsev A. B., Krasnov K. A., Shatalin V. A. Traumatic liver injury. Polytrauma. 2023; 1: 34–8 (In Russ.).

7. Chalyk Yu. V., Katalnikov A. E. Bulletin of Medical Internet Conferences. 2011; 1 (2): 20–2 (In Russ.).

8. Coccolini F., Coimbra R., Ordonez C., Kluger Y., Vega F., Moore E. E., et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020; 15 (1): 24. DOI: 10.1186/s13017-020-00302-7

9. Monchal T., Hornez E., Prunet B., Beaume S., Marsaa H., Bourgouin S., et al. Hospital care in severe trauma: Initial strategies and life-saving surgical procedures. J Visc Surg. 2016; 153 (4 Suppl): 3–12. DOI: 10.1016/j.jviscsurg.2016.04.014

10. Singh A., Prasad G., Mishra P., Vishkarma K., Shamim R. Lessons learned from blunt trauma abdomen: Surgical experience in level I trauma centre. Turk J Surg. 2021; 37 (3): 277–85. DOI: 10.47717/turkjsurg.2021.4886

11. Brigode W., Adra A., Capron G., Basu A., Messer T., Starr F., et al. The American Association for the Surgery of Trauma (AAST) liver injury grade does not equally predict interventions in blunt and penetrating trauma. World J Surg. 2022; 46 (9): 2123–31. DOI: 10.1007/s00268-022-06595-w

12. Sokolova L. A., Gorlova I. A., Omelchenko M. Yu., Bondarenko B. B. Commotio cordis as cause of sudden cardiac death associated with chest trauma. Translational Medicine. 2022; 9 (1): 5–11 (In Russ.). DOI: 10.18705/2311-449-2022-9-1-5-11

13. Kotelnikova L. P., Grebenkina S. V., Trushnikov D. V. Bile leakage after liver resection. Experimental and Clinical Gastroenterology. 2018; 8: 99–106 (In Russ.).

14. Sakamoto K., Tamesa T., Yukio T., Tokuhisa Y., Maeda Y., Oka M. Risk factors and managements of bile leakage after hepatectomy. World J Surg. 2016; 40 (1): 182–9. DOI: 10.1007/s00268-015-3156-8

15. Yoshioka R., Saiura A., Koga R., Seki M., Kishi Y., Yamamoto J. Predictive factors for bile leakage aft er hepatectomy: analysis of 505 consecutive patients. World J Surg. 2011; 35 (8): 1898–903. DOI: 10.1007/s00268-011-1114-7

16. Huang Y. K., Hsieh H. C., Tsai F. C., Chang S. H., Lu M. S., Ko P. J. Visceral artery aneurysm: risk factor analysis and therapeutic opinion. Eur J Vasc Endovasc Surg. 2007; 33 (3): 293–301. DOI: 10.1016/j.ejvs.2006.09.016

17. Zolotukhin K. N., Polyakov I. V., Samorodov A. V. Comparative analysis of circulatory dynamics monitoring with heartbeat monitor “TRITON” vs. “PICCO PLUS”. Togliatti Medical Council. 2012; (3–4): 19–23. (In Russ.).

18. Haghighatkhah H., Sanei Taheri M., Kharazi S. M., Zamini M., Rabani Khorasgani S., Jahangiri Zarkani Z. Hepatic artery aneurysms as a rare but important cause of abdominal pain; a case series. Arch Acad Emerg Med. 2019; 7 (1): e25. PMID: 31432035.

19. Gorbatykh A. V., Latkin O. E., Prokhorikhin A. A., Zubarev D. D., Chernyavsky M. A. Modern view on the treatment of oncological diseases by endovascular methods. Translational Medicine. 2022; 9 (4): 33–40 (In Russ.) DOI: 10.18705/2311-4495-2022-9-4-33-40

20. Kudaravalli P., Garg N., Pendela V. S., Gambhir H. S. Hemorrhagic pancreatic pseudocyst: A rare complication. Am J Emerg Med. 2021; 43: 243–4. DOI: 10.1016/j.ajem.2020.03.020

21. Kolotukhin A. K., Bakanov A. Yu., Bautin A. E., Volkov V. V., Mazurok V. A., Mazokhina O. V., et al. Infl uence of the Trendelenburg position and carboxyperitoneum on cerebral tissue oximetry values. Translational Medicine. 2022; 9 (2): 59–69 (In Russ.). DOI: 10.18705/2311-4495-2022-9-2-59-69