Complex Liver Injury—a Quagmire to a Trauma Surgeon

  • Harshit AgarwalEmail author
  • Abhinav Kumar
  • Amit Gupta
  • Subodh Kumar
  • Sushma Sagar
  • Biplab Mishra
Case Report


Non-operative management has become a norm in patients with liver trauma and operative management is guided by hemodynamic status. Introduction of haemodynamic status. Introduction of contrast enhanced computed tomography (CECT) abdomen has made NOM possible by helping in exclusion of other injuries and identification of vascular injuries. Haemodynamic instability is now considered as an only absolute indication for operative intervention in liver injuries. However, liver trauma is associated with a large number of complications in the form of perihepatic abscess, hepatic necrosis, bile leak, etc. Patient’s undergoing operative intervention for liver trauma are more at risk for these complications. As such regular dynamic assessment is required for early identification and management of these complications. We present a case of a complex liver injury in a 27-year-old male who underwent operative intervention for liver trauma and had a varied number of liver trauma associated complications, with enterohepatic fistula as one of the rarest associated complications.


Enterohepatic fistula Damage control surgery Liver trauma Angioembolisation Haemorrhage 



Non-operative management


Contrast enhance computed tomography


Intensive care unit


Focussed assessment with sonography in trauma


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.


  1. 1.
    Burlew CC, Moore EE (2010) Injuries to the liver, biliary tract, spleen, and diaphragm. In: Seuba WW, Fink MP, Jurkovich GJ et al (eds) ACS Surgery: Principles and Practice, Decker Intellectual properties. WebMD Publishing, New YorkGoogle Scholar
  2. 2.
    Polanco P, Leon S, Pineda J, Puyana JC, Ochoa JB, Alarcon L, Harbrecht BG, Geller D, Peitzman AB (2008) Hepatic resection in the management of complex injury to the liver. J Trauma 65:1264–1270CrossRefGoogle Scholar
  3. 3.
    Coccolini F, Montori G, Catena F, Di Saverio S, Biffl W, Moore EE, Peitzman AB, Rizoli S, Tugnoli G, Sartelli M, Manfredi R (2015) Liver trauma: WSES position paper. World J Emerg Surg 10(1):39CrossRefGoogle Scholar
  4. 4.
    Ji W-B et al (2017) Arterial embolization in treatment of hepatic artery pseudoaneurysm. Acta Med Mediterr 33.3:449–455Google Scholar
  5. 5.
    Dabbs DN, Stein DM, Scalea TM (2009) Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries. J Trauma 66:621–627CrossRefGoogle Scholar
  6. 6.
    Lee YH, Koo JS, Jung CH, Chung SY, Lee JJ, Kim SY, Hyun JJ, Jung SW, Choung RS, Lee SW, Choi JH (2013 Nov 21) Development of enterohepatic fistula after embolization in ileal gastrointestinal stromal tumour: a case report. World J Gastroenterol: WJG 19(43):7816CrossRefGoogle Scholar
  7. 7.
    Jeeson R (2015) Enterohepatic fistula associated with liver abscess-an extremely rare presentation. J Evid Based Med Healthc 2(1):60–65CrossRefGoogle Scholar
  8. 8.
    Van Backer JT, Lee EC (2017) Enterohepatic fistula in a Crohn’s disease patient: a case report. Int J Surg Case Rep 39:69–71CrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2019

Authors and Affiliations

  • Harshit Agarwal
    • 1
    Email author
  • Abhinav Kumar
    • 1
  • Amit Gupta
    • 1
  • Subodh Kumar
    • 1
  • Sushma Sagar
    • 1
  • Biplab Mishra
    • 1
  1. 1.Division of Trauma Surgery & Critical CareJPNATC, AIIMSNew DelhiIndia

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