A case of combined use of endoscopic drainage and percutaneous drainage for traumatic liver injury type III b

Abstract

Liver injuries caused by blunt abdominal trauma are common, and bile duct injuries requiring treatment comprise 4% to 23% of liver injuries. We encountered a patient who had type IIIb (Japanese Society of Trauma classification) liver injury accompanied by bile duct injury, which was treated conservatively with endoscopic nasobiliary drainage (ENBD) and percutaneous subcapsular drainage. The advantage of ENBD is that cholangiography is a simple procedure that does not require additional endoscopic retrograde cholangiopancreatography (ERCP) because stent removal is not required. Regarding the treatment of traumatic bile leakage, there are many reports of papillotomy and biliary stent placement, and conservative treatment is possible in about 90% of patients. However, ENBD may be the first choice because it is less invasive than the above treatments. In addition, in cases of poorly controlled bile leakage, it may be possible to avoid open surgery by additionally performing percutaneous drainage under the hepatic capsule.