Biliary Complication Under Nonoperative Management in High‐Grade Liver Injury: A Case Report

ABSTRACT In children, nonoperative management (NOM) of (isolated) blunt solid organ injury is an established treatment method in hemodynamically stable patients. Although close monitoring and meticulous reevaluation are mandatory, complications may occur and may need diagnostic or therapeutic adjuncts. Traumatic bile leak (TBL) is a rare but serious complication after blunt abdominal trauma and requires a multidisciplinary approach. We report a 13‐year‐old male with an American Association for the Surgery of Trauma (AAST) grade IV liver injury after blunt abdominal trauma qualifying for NOM after initial hemodynamic stabilization. The clinical course was complicated on day 8 with an increasing amount of intra‐abdominal free fluid. Laparoscopic exploration later confirmed the diagnosis of biliary leak. Biliary stenting and iterative endoscopic retrograde cholangiopancreatography (ERCP) procedures were performed, finally documenting a successful management of the biliary leak. Pediatric trauma surgeons must be aware of possible complications in patients with high‐grade liver injuries under NOM. TBL is a rare but serious complication in blunt liver injury. There is little scientific evidence on the best management of TBL, so an individualized and interdisciplinary strategy is crucial. ERCP may be considered as an adjunct in the NOM in appropriate cases.