TRAUMATIC BILHEMIA

Background. Retrospective analysis was done of three cases with severe liver trauma and excessive serum bilirubin levels caused by a traumat ic biliovenous fistula. The literature is reviewed. Methods. Diagnosti c measures included laboratory findings, computed tomography, ultrason ography, and endoscopic retrograde cholangiopancreatography (ERCP). Re sults. The biliovenous fistula was detected by ERCP in two cases. In o ne case a left hemihepatectomy was carried out, and the patient was cu red. Th other patient received drainage of a huge necrotic cavity in t he center of the liver. Ten months later the patient underwent reopera tion, and left hepatic resection was performed. The patient died of li ver function failure on postoperative day 7. In the third case the fis tula subsided spontaneously. Conclusions. An excessively high serum le vel of direct bilirubin and only moderately elevated liver enzymes ind icate bilhemia in trauma patients. ERCP is most reliable in localizing the fistula; computed tomography/ultrasonography are valuable in dete cting the extension and localization of the parenchymal destruction. C onservative therapy is justified if the patient is in good condition o r if the localization of the fistula is unclear. Spontaneous closure o f the fistula may occur. Surgical treatment options are partial liver resection and suture of the fistula and T-tube drainage of the common bile duct and drainage of the rupture site.