A 55-year-old male with a history of abdominal traumatism was admitted due to abdominal pain, deaf and diffuse, without peritoneal signs and with hemodynamic stability.
Ascites was observed in the initial ultrasound of the emergency department.
During the first 48 hours there was an increase of ascites and fever.
Analytically it was highlighted: hemoglobin, 10 mg/dl; GGT, 104 U/l, and CRP, 266 mg/dl. Abdominal tomography (CT) was requested and piperacillin-tazo started.
A paracentesis was performed for five causes (hematitis: 21,000/mm3, 2,880 leukocytes/mm3, total bilirubin: 19.26 mg/dl, bile acids: 3,952.4 μmol/l).
With the suspicion of biliary leakage endoscopic retrograde cholangiography (ERCP) was performed, which showed vesicular leakage, treated by sphincterotomy and placement of a 10 Fr biliary plastic stent for eight weeks with good evolution.
