Enteral bile reinfusion in severe abdominal trauma

Abstract

Enteral reinfusion of bile is a rarely used technique in critical care, primarily indicated for treating digestive intolerances due to biliary fistulas. This case report presents a 22-year-old male who sustained closed abdominal trauma, resulting in bile duct injury and a high-output biliary fistula. The patient, initially intolerant to enteral feeding and showing signs of gastroparesis, was treated with bile reinfusion through the nasoenteric route, leading to good tolerance of food without complications. The liver secretes 600 to 1000 ml of bile daily, and injuries to the duodenal, pancreatic, and biliary tracts can cause excessive fluid output, leading to bile acid deficiency and associated complications like fat malabsorption, diarrhea, and electrolyte imbalances. In such scenarios, bile reinfusion can be an effective treatment method, providing a low-cost alternative to exogenous bile acid replacement and reducing the need for fluid resuscitation. This case involved a young man who suffered severe polytrauma from a vehicle collision, leading to a burst-type injury to the second duodenal portion. Initial surgical interventions included duodenal suture and gastroenteroanastomosis. Following complications, a second surgery was performed, externalizing bile and pancreatic fluids. Despite initial exclusive parenteral nutrition, enteral feeding was introduced but led to digestive intolerance. Subsequently, bile reinfusion was implemented, resulting in stable patient evolution, symptom resolution, and no complications. The reinfusion protocol included sterile collection of bile, reinfusion every 6 hours using a continuous infusion pump, and co-administration with enteral nutrition. The patient tolerated the procedure well, with no adverse effects observed over six weeks. This case highlights the potential of bile reinfusion as a viable, cost-effective intervention for patients with duodenal or bile duct injuries, particularly in the absence of extensive literature on its use in traumatic contexts. Further studies are warranted to validate the efficacy and safety of this technique in broader clinical settings