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Intrahepatic hematoma with secondary Salmonella infection via biliary fistula
H Cerwenka1, G Werkgartner, H Bacher
1Department of General Surgery, University Clinic of Surgery, Karl-Franzens University, School of Medicine, Graz, Austria.
Abstract:
Usually liver hematoma after blunt trauma is treated conservatively as long as clinically possible, in order to avoid infection via drainage. We report a patient who developed a huge liver abscess after a minor blunt trauma caused by a piece of wood that hit his hepatic region during work with a circular saw. Neither conservative treatment nor percutaneous drainage was successful and intraoperatively a biliary fistula was identified as the route of infection by salmonella. Cholecystectomy (here meaning removal of the salmonella reservoir) and consequent drainage of the gall flow via T-drain were the crucial therapeutic steps and the fistula finally closed after three months. Therapeutic possibilities in the management of blunt liver trauma, and biliary and septic complications are discussed.
Insights
A liver abscess developed in a patient after blunt hepatic trauma. Surgical intervention, including cholecystectomy and T-drainage, successfully treated the biliary fistula and Salmonella infection, leading to abscess resolution.
Area of Science:
- Gastroenterology
- Trauma Surgery
- Infectious Diseases
Background:
- Liver hematomas from blunt trauma are typically managed conservatively to prevent infection.
- Minor hepatic trauma can lead to severe complications, including abscess formation.
- Salmonella species are a potential cause of liver abscesses, often linked to biliary pathology.
Observation:
- A patient sustained a liver abscess following minor blunt hepatic trauma from a circular saw incident.
- Initial conservative management and percutaneous drainage failed to resolve the abscess.
- Intraoperative findings revealed a biliary fistula as the source of Salmonella infection.
Findings:
- Cholecystectomy, to remove the Salmonella reservoir, was a critical step in treatment.
- T-tube drainage of bile flow facilitated the closure of the biliary fistula.
- The liver abscess resolved completely three months after the surgical intervention.
Implications:
- This case highlights the potential for significant biliary and septic complications after seemingly minor blunt liver trauma.
- Aggressive surgical management, including addressing the biliary source, may be necessary when conservative measures fail.
- Understanding the interplay between trauma, biliary anatomy, and infection is crucial for effective patient management.