A Case Series on Combat-Related Liver Injuries: Intrahepatic Biloma As A Complication and Pigtail Drainage As A Solution

Abstract

Combat-related liver injuries are among the most challenging abdominal traumas due to the high risk of massive hemorrhage, complex associated injuries, and limitations in battlefield medical resources. Rapid surgical intervention remains the cornerstone of management, particularly when non-operative management is not feasible. In this case series, two soldiers with liver injuries underwent emergency laparotomy with direct repair, both later complicated by biloma formation. These were successfully treated with ultrasound-guided pigtail drainage, avoiding reoperation and facilitating recovery. Both patients were discharged in stable condition following structured multidisciplinary care. The cases underscore the critical role of timely surgical intervention, vigilant imaging surveillance, and minimally invasive drainage techniques in reducing morbidity. The integration of damage control principles, early resuscitation, and vigilant postoperative care has significantly improved survival in recent years. A notable complication in liver injuries is the development of bilomas, which may prolong recovery and increase morbidity if not promptly addressed. Minimally invasive approaches, such as ultrasound-guided pigtail catheter drainage, have proven highly effective in managing these collections, avoiding the need for reoperation and reducing patient burden. The application of such adjunctive techniques, alongside critical care support and early mobilization, reflects the evolving standards of combat trauma management. Lessons drawn from these experiences emphasize the importance of multidisciplinary collaboration, adaptability in resource-limited settings, and the translation of combat trauma strategies to civilian practice.