A 39-year-old male, an excessive smoker and parenterally addicted to drugs under methadone treatment, who came to the Emergency Department of our hospital because he had a penetrating wound in three centimeters of epiphyseal plate.
Epiploic content is objectively preserved.
Emergency surgery was decided.
A midline laparotomy was performed, finding hemoperitoneum (600 ml) and lacerating wound on the anterior side of the left hepatic lobe in segment II with pathway to segment V, as well as on the posterior segment VII.
Hemostasis was performed with Surgicel® and raffia with Parenchymaset®, ending with the placement of two drainages.
Intensive care unit stayed three days.
At the 17th day of the surgery, a bilious output of 500 cc was found by one of the drains without clinical repercussions. Through CAT scan a minimum amount of free fluid was diagnosed with high suspicion of biliary fistula.
Drainage output was maintained around 350-400 cc for 15 days, during which magnetic resonance cholangiography was performed and reported as biliary leakage with normal gallbladder, gallbladder and Wirsung tree.
Because of the radiological diagnosis and the absence of severe perihepatic manifestations, it was decided to perform postural treatment while maintaining the patient in the right lateral decubitus position.
The results in the first 24 hours were encouraging, decreasing the biliary output from 300 to 75 cc, remaining around 50-20 cc the following week and disappearing the fistula in nine days.
