ECMO-/ECLS

A complication that is uniquely associated with severe hepatic injuries is
the development of a bile leak from disrupted liver parenchyma or a disrupted
bile duct. At the time of operation, closed suction drains should be placed
around the liver, particularly if a non-anatomic resection was performed. In
cases of non-operative management, a significant bile leak may manifest by
feeding intolerance, abdominal pain, elevations in hepatic enzymes, and fever
[20]. CT or ultrasound will reveal a fluid collection. Initial management involves
the insertion of catheters to drain the bile collection usually performed
percutaneously with image guidance. If the bile leak persists after drainage,
endoscopic retrograde cholangiopancreatography (ERCP) can be used to
identify the location of the leak, as well as the abilituy to perform a
sphincterotomy to decrease biliary pressure and promote internal drainage
[21,22]. If necessary, placement of biliary stents can also be performed, both to
improve drainage and to treat the ductal injury.
Hemobilia presents with symptoms of an upper GI bleed, such as
hematemesis or melena. Though uncommon, this symptom signifies a fistula
between a branch of the hepatic artery and the biliary tree. Angioembolization
is the treatment of choice.
B. Renal Injuries
Fortunately, the kidney is less frequently injured than the liver or spleen
with a reported incidence of approximately 10% of all abdominal traumas [23].
However, major renal injuries are more common in children than adults for the
reasons noted at the beginning of this chapter. A staging system for renal