Postoperative evaluation of penetrating hepatic trauma and complications

Postoperative hepatobiliary scintigraphy is recommended in selected cases of hepatic trauma to evaluate the integrity and patency of the biliary system. We present a patient with a traumatic hematoma that eventuated in a biloma with spontaneous biliary-cutaneous fistula. Repeat study demonstrated biliary obstruction at the canalicular level, which by more invasive imaging was found secondary to total obstruction of the common hepatic duct. The precise anatomical level and cause of his obstruction were defined by the findings of endoscopic retrograde cannulation of the pancreas, percutaneous transhepatic cholangiography, and surgery.