Delayed laparoscopy facilitates the management of biliary peritonitis in patients with complex liver injuries

Surgical Endoscopy
E H CarrilloJ David Richardson

Abstract

Nonoperative management is now regarded as the best alternative for the treatment of patients with complex blunt liver injuries. However, some patients still require surgical treatment for complications that were formerly managed with laparotomy and a combination of image-guided studies. We reviewed the medical records of 15 patients who had complex blunt liver injuries that were managed nonoperatively and in which biliary peritonitis developed. Delayed laparoscopy was performed 2-9 days after admission in patients with extensive liver injuries. All 15 patients had developed local signs of peritonitis or a systemic inflammatory response. Laparoscopy was indicated to drain a large retained hemoperitoneum (eight patients), bile peritonitis (four patients), or an infected perihepatic collection (three patients). Laparoscopy was successful in all patients, and there was no need for further interventions. The data indicate that as more patients with complex liver injuries are treated nonoperatively and the criteria for nonoperative management continue to expand, more patients will need some type of interventional procedure to treat complications that historically were managed by laparotomy. At this point, laparoscopy is an excellent...Continue Reading

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Citations

Feb 6, 2008·Cardiovascular and Interventional Radiology·Valérie MonninGilbert Ferretti
Mar 20, 2002·The Journal of Trauma·Eddy H CarrilloHiram C Polk
Dec 31, 2005·The Journal of Trauma·Rosemary A KozarFrederick A Moore
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Sep 17, 2010·World Journal of Emergency Surgery : WJES·Ettore MarzanoPatrick Pessaux
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Nov 30, 2010·Journal of Visceral Surgery·A-F BourasF-R Pruvot
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