DOI  10.17613/2cac7-85c05 

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Case Studies

Blunt Abdominal Trauma with Grade III Hepatic Injury and High-Output Bile Leak: Case Report and Literature Review

Carrera-Holguín Alejandra*¹; Gámez-Fragoso Octavio Mario Francisco¹; Estrada-Chacón Cecilia Estefania¹; Santos-Vega Adrián Alberto²; Proa-Arriaga Alejandra Yovanka²; Martínez-Cuspinera Fernando²; Sánchez-González Sergio Daniel². 

*Correspondence: alejandracarreraholguin@gmail.com ORCID: 0009-0002-2536-4137

¹Department of General Surgery, General Hospital of Torreón, Torreón, Coahuila, Mexico.

²Department of General Surgery, University Hospital of Saltillo, Saltillo, Coahuila, Mexico.

Keywords: Liver trauma, biliary leak, ERCP failure, somatostatin, conservative management.

Background: The liver is one of the most injured organs in blunt abdominal trauma. While most hepatic injuries can be managed conservatively, high-output biliary leaks remain a rare but serious complication. The choice between surgical, endoscopic, or conservative treatment depends on the site of the leak, the output volume, and the patient’s clinical condition.

Case Presentation: We report a 30-year-old male with a history of substance abuse who sustained blunt abdominal trauma following physical aggression. Exploratory laparotomy revealed a grade III hepatic laceration in Couinaud segment VIII with active bleeding and bile leakage, draining 315 cc of bile per 24 hours. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a leak from a branch of the right hepatic duct, but stent placement failed. The patient was managed conservatively with somatostatin analogs, achieving a progressive reduction in bile output to 17 cc/day by day 8. He tolerated oral intake and recovered without additional intervention.

Results: Imaging follow-up showed no intrahepatic duct dilation or intra-abdominal collections. The patient remained hemodynamically stable and was discharged with favorable evolution. The outcome supports the role of medical therapy in selected cases after failed endoscopic intervention.

Conclusions: Conservative management using somatostatin analogs may be an effective option for high-output biliary leaks in stable patients when ERCP fails. A stepwise, individualized approach based on clinical stability and anatomical considerations is essential. More evidence is needed to standardize therapeutic algorithms.