Delayed laparoscopy facilitates the management of biliary peritonitis in patients with complex liver injuries

Background: Nonoperative management is now regarded as the best alternative for the treatment of patients with complex blunt liver injuries. However, some patients still require surgical treatment for complications that were formerly managed with laparotomy and a combination of image-guided studies. Methods: We reviewed the medical records of 15 patients who had complex blu nt liver injuries that were managed nonoperatively and in which biliary per itonitis developed. Results: Delayed laparoscopy was performed 2-9 days after admission in pati ents with extensive liver injuries. All 15 patients had developed local sig ns of peritonitis or a systemic inflammatory response. Laparoscopy was indi cated to drain a large retained hemoperitoneum (eight patients), bile perit onitis (four patients), or an infected perihepatic collection (three patien ts). Laparoscopy was successful in all patients, and there was no need for further interventions. Conclusion: The data indicate that. as more patients with complex liver inj uries are treated nonoperatively and the criteria for nonoperative manageme nt continue to expand, more patients will need some type of interventional procedure to treat complications that historically were managed by laparoto my. At this point, laparoscopy is an excellent alternative that should beco me part of the armamentarium of the trauma surgeons who treat these patient s.