A scheduled ERCP application is an effective approach for the management of EBF, and liver resection could be avoided. A combination of operative and nonoperative techniques for the management of the combat GSW to the liver is effective along with the application of damage control tactics. Partial EBF was diagnosed from the main wound defect of the liver and closed without surgical interventions on the 34th day after the injury. Occlusion of the stent was treated by stent replacement, and scheduled ERCP was performed. Biliary decompression was achieved by endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and the placement of biliary stents. Damage control tactics were applied at all four levels of military medical care. A 23-year-old male was diagnosed with thoracoabdominal penetrating gunshot wound (GSW) by a high-energy multiple metal projectile. Also, little is known about the features of combat trauma and its management in ongoing hybrid warfare in East Ukraine. Biliary decompression is commonly applied for the management of EBF. Bile leak and external biliary fistula (EBF) are common complications. The combat penetrating gunshot injury is frequently associated with damage to the liver.
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