Evaluation of Bile Leakage after Blunt Liver Trauma in Child
Case 1

A 5 year old boy was admitted at the emergency room after having been run over by a car. He sustained bilateral hemopneumothorax, bilateral pulmonary contusion, right kidney injury, an unstable pelvic ring fracture, and a right femoral neck fracture. He was intubated and fluid resuscitation was commenced. Bilateral chest tubes were inserted because of hemopneumothorax. A CT scan with intravenous contrast revealed grade III injury in the right liver lobe (Figure 1a) and grade 3 injury of the right kidney. With the patient under general anesthesia, an interventional radiologist performed transcatheter arterial embolization (TAE) to embolize the injured hepatic and pelvic arteries. The anesthesiologist continued resuscitation throughout the embolization procedure. Extracorporeal membrane oxygenation was initiated because of severe respiratory failure on day 1 and weaned on day 5. The femoral neck fracture was repaired on day 17. The patient became jaundiced, and a CT scan showed the presence of free fluid in the left upper quadrant of the peritoneal cavity. An external drain placed under ultrasound guidance yielded bile-stained fluid. On day 25, drip infusion cholangiography with computed tomography (DICCT) (2 mL/kg body weight of meglumine iotroxate) clearly showed a right biliary duct injury and contrast leakage (Figure 1b). On day 44, therapeutic ERCP was performed under general anesthesia, because the bile-stained fluid from the peritoneal drain persisted.ERCP demonstrated a partial tear of the right intrahepatic bile duct (Figure 1c). A 5-Fr, 7-cm endoscopic retrograde biliary drainage tube was inserted across the ampulla (Figure 1d). The bile leakage was stopped, and the biliary drainage tube was removed on day 65. The peritoneal drain was removed on day 78. Follow-up ultrasound demonstrated no ascites or bile duct dilatation....

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