Bicycle handlebar injury in a child resulting in complex liver laceration with massive bleeding and bile leakage : a case report
ID Grosek, Jan (Author), ID Čebron, Žan (Author), ID Janež, Jurij (Author), ID Tomažič, Aleš (Author)

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INTRODUCTION: Bicycle accidents are a significant cause of traumatic morbidity in the paediatric population. The handlebar injuries are usually isolated and remain a major source of bicycle related morbidity. We present a case of severe liver laceration with left hepatic ducttransection caused by handlebar trauma in a 13-year-old boy. CASE PRESENTATION: An otherwise healthy 13-year-old Caucasian male patient was rushed to the hospital following a blunt abdominal trauma from a bicycle handlebar. An ultrasound revealed extensive free intraperitoneal fluid with accompanying features of hemodynamic instability. Operative findings included massive haemoperitoneum, a deep laceration almost separating left and right liver lobes, and a near-complete interruption of the left hepatic duct. Interestingly, the vascular anatomy of the left liver lobe was preserved. After haemostasis was established a duct-to-duct anastomosis of the ruptured left hepatic duct was performed. A T-tube biliary drainage was inserted, and intraoperative cholangiography showed no extraluminal spillage of contrast. During the recovery phase, cholangiography was performed several times revealing leakage from left hepatic duct. The leakage was managed conservatively and finally stopped. DISCUSSION: Management of blunt hepatic injuries has remarkably changed from mandatory operation to mostly nonoperative interventions with selective operative management. Hemodynamic instability remains the main reason for exploratory laparotomy. Near-isolated laceration of main hepatic ducts is an extremely rare finding, and immediate reconstruction is the best option if an experienced surgeon is available. CONCLUSION: Due to limited evidence, we recommend consultation with an experienced HPB surgeon on a case-by-case basis for every paediatric biliary injury.

Keywords:bicycle accidents, handlebar injury, liver laceration, pediatric trauma, case report
Work type:Article (dk_c)
Typology:1.03 - Short Scientific Article
Organization:MF - Faculty of Medicine
Publication status in journal:Published
Article version:Publisher's version of article
Number of pages:Str. 386-390
Numbering:Vol. 72
PID:20.500.12556/RUL-138419 This link opens in a new window
ISSN on article:2210-2612
DOI:10.1016/j.ijscr.2020.06.049 This link opens in a new window
COBISS.SI-ID:20107267 This link opens in a new window
Publication date in RUL:20.07.2022
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Record is a part of a journal

Title:International journal of surgery case reports
Publisher:Elsevier, IJS Publishing Group
COBISS.SI-ID:519426585 This link opens in a new window


License:CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Description:The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.

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