Management of liver biloma after gunshot thoraco-abdominal injury: case report

Abstract

Introduction. During the Russian armed aggression against Ukraine, a large number of Ukrainian civilians were injured or killed since 2022. The rate of penetrating abdominal injuries during active military action varies from 2 % to 15 %. The small intestine, colon, liver and intra-abdominal vessels are most often affected. Patients with gunshot abdominal injuries and liver lacerations are more likely to have specific complications such as necrosis or abscesses, bilomas or biliary leakage. Ultrasound-guided drainage is a common treatment of biloma, but persistent bile leakage requires further endoscopic or surgical treatment and remains an important issue that needs to be resolved. Aim. To present a case report of liver biloma management after gunshot thoraco-abdominal injury. Case presentation. We present the case of a 22-year-old man who got a penetrating gunshot thoraco-abdominal wound with the damage to the VI-VII segments of the liver as a result of military operations. Among other surgical interventions, the patient underwent cholecystectomy with external drainage of the common bile duct. The case was complicated by the formation of liver and subhepatic bilomas, which required drainage under ultrasound control. Prolonged bile secretion from the drainage in the amount of about 100-150 ml per day prompted the search for a solution to this problem and providing of endoscopic internal bile drainage. It allowed to terminate bile leakage and remove drainage from the liver and subhepatic space. Discussion. The case is noteworthy, as the literature review found few reports of bilomas in patients after gunshot injuries of the liver and no cases were found that were the result of military operations. Conclusions. Endobiliary drainage in a patient with a gunshot liver injury allows to effectively treat biliary leakage. The use of such endoscopic method in the treatment of patients with gunshot liver injuries complicated by bilomas is an actual issue that needs to be studied.