International Journal of Research in Medical Sciences | May 2023 | Vol 11 | Issue 5 Page 1783 International Journal of Research in Medical Sciences Sanchez OS et al. Int J Res Med Sci. 2023 May;11(5):1783-1786 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Case Report Biloma secondary to blunt liver trauma in a pediatric patient: case report Omar Sosa Sánchez 1 *, Fernando Navarro Tovar 2 , Mónica Heredia Montaño 2 , Cheryl Zilahy Díaz Barrientos 2 , Mildred Philippe Ponce 2 , Yoselin Julisa Sarabia Pérez 2 INTRODUCTION In a general context of abdominal trauma, the liver is the organ most frequently injured after blunt or penetrating abdominal trauma. 1,2 Hepatic trauma in children is a pathology that has a growing incidence mainly because children are increasingly involved in potentially dangerous games and adventure sports, and to constant car accidents. 2 The most frequent cause of death in children is usually associated with trauma, so timely treatment and complications are particularly important. 3 Liver injuries in children occur as a result of compression of the abdomen and thorax due to high energy trauma, such as traffic accidents and falls in height; originating mainly from trauma in the upper right quadrant of the abdomen or right hemithorax, most often injuring the right hepatic lobe, due to its location and size. 4 Non-operative management is the hallmark of treatment for the vast majority of children suffering from blunt liver injury; guidelines for the proper use of resources based on the tomographic grade of liver injury have existed for more than a decade, but recent literature reports management based primarily on the hemodynamic state of the patient. 5 Despite the optimal results and the minimal morbidity derived from non- operative management, cases of secondary bile leakage have been described, which can affect the intra or extrahepatic tract and, depending on their presentation, are divided into bilomas, which are collections of bile contained, or biliary fistulas that may be bilioarterial, biliovenous, biliocutaneous or leaking to peritoneum. 6 Due to the low incidence of biliary complications secondary to hepatic trauma in pediatrics and the importance of its early recognition, we consider it important to report the case of a pediatric patient who presented with a biloma secondary 1 Department of General Surgery, University Hospital de Puebla, Puebla, México 2 Department of General Surgery, University Hospital of Puebla, BUAP, Puebla, Mexico Received: 11 April 2023 Accepted: 26 April 2023 *Correspondence: Dr. Omar Sosa Sánchez, E-mail: dr.omarsosa10@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Liver is the organ most frequently injured after blunt or penetrating abdominal trauma, being in pediatrics a pathology that has an increasing incidence; Non-operative management is the hallmark of treatment, however cases of secondary biliary leakage have been described, which may affect the intrahepatic or extrahepatic track. A male 8 years old, with blunt trauma in the right hypochondrium, presenting acute abdomen and hemodynamic instability, requiring exploratory laparotomy with a grade III liver injury in VI and VII hepatic segments. Four weeks after discharge, he presented as a complication a giant biloma in VII and VIII hepatic segments, performing percutaneous drainage guided by ultrasound. The incidence of biliary complications related to hepatic trauma is low, 4% in pediatric patients, dividing into bilomas or biliary fistulas; the presentation of biliary leakage is very non-specific and early diagnosis difficult; in the bilomas, the tomography allows to define precisely its size, nature, distribution and regional anatomy in relation to adjacent structures, as well as underlying cause. The approach of choice is percutaneous or endoscopic drainage, with surgical management being the last option. Keywords: Liver trauma, Biloma, Liver DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20231355