SUCCESSFUL SECOND TREATMENT WITH RIGHT LOBECTOMY IN A LIVER TRAUMA PATIENT WITH DELAYED HEMOBILIA AFTER SUTURE

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  • Bilomaへのドレナージチューブ挿入後胆道出血にて二期的な肝切除を要した肝外傷の1例

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Abstract

Hemobilia and persistent fever-up following a blunt liver trauma is often a strong suspicion of infection of biloma, and may be certain signs of poor prognosis. We have experienced a successfully saved patient suffering from this status.<br> A 23-year-old male injured in a motorcycle accident was admitted to the hospital because of an abdominal pain. We diagnosed him with liver trauma classified IIIa by The Japanese Association for The Surgery of Trauma. Suturing of the liver was performed, and hemorrhaging stopped. On the 5th postoperative day (POD), abdominal CT showed a biloma. It became larger and larger, and the drainage was esterblished on the 25th POD. On the 31st POD, he suddenly had an abdominal pain, hematemesis and anal bleeding, and massive blood was found in the drainage tube. With a diagnosis of hemobilia he was treated conservatively, but hemobilia occerred often. Finally, on the 68th POD he underwent a right lobectomy. Thereafter, he was stable and discharged from the hospital on the 107th POD.<br> Biloma accompanied by liver trauma is frequently infected, and when it gets larger hemobilia should be suspected with high a probability. Radical resection of the diseased liver may be applied to such a patient.

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