Intraperitoneal hepatic bile duct fistula following blunt abdominal contusion

Injuries to intrahepatic biliary ducts rarely cause severe clinical manifestations in context with blunt abdominal trauma. A case with mild symptoms and signs, but slowly developing bile peritonitis due to posttraumatic intraperitoneal hepatic bile duct fistula is described here. A young girl sustained a blunt contusion on the right lower thoracoabdominal region by the handle bar of a bike. A week after the accident ultrasonography revealed fluid under the liver. The patient showed no signs of peritonitis but had occasional shoulder pain. At laparotomy 200 ml of biliary fluid was drained from the subphrenic space, and excoriation was observed on the upper surface of the liver. A second operation was necessary due to continuous bile leakage via the drain in the subphrenic space and a bile-fistula was demonstrated by contrast x-ray examination. A local resection of the liver was performed and the intrahepatic bile duct fistula closed by a ligature. The postoperative course was then uneventful and the patient was symptomfree on examination six months after the accident.