Журнал клинических случаев

Bicycle Handlebar Injury in a Child Resulting in Complex Liver Laceration with Massive Bleeding and Bile Leakage: A Case Report

Abstract

Grosek J, Cebron Z, Janez J and Tomazic A

Background: Bicycle accidents are a significant cause of traumatic morbidity in the paediatric population. The handlebar injuries are usually isolated and remain a major source of bicycle related morbidity. We present a case of severe liver laceration with left hepatic duct transection caused by handlebar trauma in a 13-year-old boy. Case presentation: An otherwise healthy 13-year-old Caucasian male patient was rushed to the hospital following a blunt abdominal trauma from a bicycle handlebar. An ultrasound finding of extensive free intraperitoneal fluid with accompanying features of hemodynamic instability necessitated a decision to perform an emergency exploratory laparotomy. Operative findings included massive haemoperitoneum, a deep laceration almost separating left and right liver lobes, and a near-complete interruption of the left hepatic duct. Interestingly, the vascular anatomy of the left liver lobe was preserved. Surgical haemostasis was successfully accomplished, and a duct-to-duct anastomosis of the ruptured left hepatic duct was performed. A T-tube biliary drainage was inserted, and intraoperative cholangiography showed no extraluminal spillage of contrast. During the recovery phase, cholangiography was performed several times revealing leakage from left hepatic duct. The leakage was managed conservatively and finally stopped. The boy was eventually discharged home in stable clinical condition. Conclusion: Management of blunt hepatic injuries has remarkably changed from mandatory operation to mostly non-operative interventions with selective operative management. Hemodynamic instability remains the main reason for exploratory laparotomy. Near-isolated laceration of main hepatic ducts is an extremely rare surgical finding, and immediate reconstruction is the best option if an experienced surgeon is available. Additionally, even though biliary leakage was observed after the operation, conservative treatment with T-tube left in place for a considerably long period was successful.