Non-operative management of a hepatic pseudoaneurysm and a biloma complicating a blunt abdominal trauma

Hepatic artery pseudoaneurysm and bilioma are rare complications of blunt abdominal trauma in children. We report a case in an II-year-old patient after a hepatic and splenic blunt trauma following a car accident. The initial evolution was simple with haemodynamic stability. On Day 12, a pseudoareurysm was discovered on an abdominal magnetic resonance imaging whereas the patient presented a major pain syndrome and an icteric cholestase. Embolisation was realised a few hours later in emergency because of a haemorrhagic shock. On Day 26, an endoscopic retrograde cholangiopancreatography highlighted two bilary leaks: one extrahepatic, the other intrahepatic. The first one was treated with a stent and the second one needed three drains: two peritoneal and one in the biloma. The characteristic of this case relies on the association of two complications. It underlines the need of multidiscipline and non-operative management of pediatric blunt hepatic trauma. (C) 2008 Elsevier Masson SAS. Tous droits reserves.