Delayed bile leak in a patient with grade IV blunt liver trauma: A case report and review of the literature

• A case with delayed bile leak in a young male patient who presented with grade IV blunt liver injury following a motor vehicle collision.
• In addition to a high grade injury; centrally located liver injury is a significant risk factor for major bile duct injury.
• For such patients, early MRCP and ERCP may be warranted to rule out a significant bile leak.
• Patients with high grade liver injury are at risk of serious complications.
• There is a need for prompt diagnosis and treatment of delayed bile leak in blunt liver injuries.

IntroductionDelayed bile leak following blunt liver trauma is not common.Presentation of caseWe presented a case report and literature review of delayed bile leak in a young male patient who presented with grade IV blunt liver injury following a motor vehicle collision; he was a restrained driver who hit a fixed object. Physical examination was unremarkable except for revelaed tachycardia, right upper quadrant abdominal tenderness, and open left knee fracture. A diagnosis of grade IV multiple liver lacerations with large hemo-peritoneum was made and urgent exploratory laparotomy was performed. The patient developed a biloma collection post- operatively. He underwent endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct stenting. His recovery was uneventful, and he was discharged home after 1 month.DiscussionThis is a rare case with no intra or extra hepatic biliary radicle injury seen on magnetic resonance cholangiopancreatography (MRCP) and no evidence of leak by ERCP. A review of the literature to highlight the incidence of delayed bile leak revealed only few reported cases.ConclusionOur findings demonstrate the need for prompt diagnosis and treatment of delayed bile leak in blunt liver injuries. When these principles are followed, a successful outcome is possible.