Although liver lacerations are relatively common following blunt trauma, hepatic artery injuries are rare, with only a few cases of hepatic artery dissection caused by blunt trauma reported to date. Due to its rarity, no standardized treatment protocol exists for managing such injuries. We report the case of a 22-year-old female patient referred with a suspected pancreatic injury and liver laceration following blunt trauma. Upon arrival, she presented severe abdominal pain, and a physical examination revealed significant epigastric tenderness. Emergency laparotomy confirmed pancreatic contusion and liver laceration, for which peritoneal irrigation and wide drainage were performed. On postoperative day 17, hepatic artery dissection was incidentally diagnosed with computed tomography, although the patient remained asymptomatic and laboratory tests were within normal limits. Conservative management with an antiplatelet agent was initiated. A follow-up computed tomography scan performed 4 months post trauma demonstrated complete resolution of hepatic artery dissection.

Chylothorax is mostly iatrogenic, with blunt chest trauma being a rare cause. Treatment depends on the volume of drainage. Specifically, conservative treatment, such as total parenteral nutrition and pleural drainage, is performed in cases of low daily output (< 500 mL/day). Patients with persistent chylothorax despite medical treatment or with high daily output (> 1-1.5 L/day) are candidates for surgical or radiological intervention. We present a case of delayed-onset chylothorax after blunt trauma caused by thoracic spine fractures, in which persistent chylothorax was successfully managed with repeated lymphangiography with lipiodol when other treatment modalities failed. The case is peculiar in that the chylothorax occurred 40 days after the initial traumatic event and was treated with lipiodol injection, despite maintaining moderate to high daily output.

Bladder injury is uncommon in blunt abdominal trauma. The injury can be life-threatening if not treated properly. Thus, timely and accurate diagnosis is critical. Traumatic intraperitoneal bladder rupture (TIBR) can be managed laparoscopically in patients who are hemodynamically stable. In this case series, we present 3 patients who underwent laparoscopic repair of TIBR performed by a single surgeon. In addition, we address useful technical tips that would facilitate the generalized use of laparoscopy for treating TIBR.

Citations

• Bladder trauma: a guideline of the guidelines
  Deshin Reddy, Abdullah E. Laher, Maeyane Moeng, Ahmed Adam
  BJU International.2024; 133(4): 365.     CrossRef