Case report
BioGlue for traumatic liver laceration

https://doi.org/10.1016/j.ijscr.2016.03.039Get rights and content
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Highlights

  • MVC with blunt abdominal trauma with grade 4 liver injury, grade 3 splenic injury found. An exploratory laparotomy was performed with packing of liver laceration. Abdominal pain, distention and ileus persisted.

  • CT performed showing centrally located bile leak with biloma and HIDA showing extravasation at right main hepatic duct. Gastroenterology consulted, endoscopic stent placed.

  • Returned to operating room for evacuation of bilomas with 3 liters drained and BioGlue placed at site of liver laceration.

Abstract

Introduction

Advances in diagnostic imaging and monitoring have led to a shift towards primary non-operative management for most blunt liver injuries. Hemostatic biologic agents are a potential adjunct in the treatment of bile leak, especially in patients requiring surgery for drainage of a biloma.

Presentation of case

We present a 31 year old woman who presented to the hospital after a motor vehicle accident. She was found to have a Grade 4 liver injury causing hemoperitoneum. The patient was taken immediately for an exploratory laparotomy where the laceration was packed with an absorbable hemostatic mesh. On clinic follow-up one week after discharge, the patient was found to have a bile leak. An ERCP was performed and a stent was placed over the location of the leak. The patient underwent laparotomy the following day for evacuation of her bilomas. The liver laceration was identified and remained at the same depth. CryoLife Bioglue was used to seal the laceration.

Discussion

Given the high volume biloma, it is unlikely this patient would have been successfully treated without laparotomy. As such, this was an ideal opportunity to utilize Bioglue as an adjunct to seal the liver laceration, and thus potentially the area of bile extravasation. The diversion of drainage using ERCP was likely to have reduced the volume of bile leak substantially, which would also have helped increase the efficacy of the procedure.

Conclusion

The case presented demonstrates a novel and safe option for the delayed repair of traumatic lacerations.

Keywords

Trauma
Liver laceration
BioGlue
Bile leak
Endoscopic stenting
Biloma

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