Blunt liver injuries in children: the role of nonoperative management

ABSTRACT

Background: Nonoperative management (NOM) is presently considered the treatment modality of choice for hemodynamically stable patients sustaining blunt liver trauma, especially in children. Objective: To evaluate role of NOM of blunt liver injuries (BLI) in children at National Hospital of Pediatrics. Subjects and method: Therecords ofallthe patientstreatedin National HospitalofPediatricswithfinaldiagnosisBLI betweenJanuary2000 and December 2006 were reviewed. The clinical signs,investigations,imagingstudies, methods oftreatmentandresultswereanalysed.Theliverinjuriesweregradedaccordingtothe American AsociationfortheSurgeryofTrauma(AAST).Results: There were15patients from one dayto 12 years of age with average BLI grade 2.5; 14 patients with precise diagnosis BLI were atempted NOM, 1 neonate was operated with diagnosis intraabdominal haemorrhage (BLI grade II found intraoperatively). Two patients (BLI grade II and V) from the atempted NOM group were operated thereafter because of hemodynamical instability or continuing bleeding, the remained 12recovered well with average hospital stay of 7.5 days. The rate of succesful NOM for BLI in our series was 12/14 (85.7%). Conclusions: NOM can be applied safely for BLI in children with high successful rate. Patients\ufffd?hemodynamic status may be more important for treatment decision-making than the injury grade according to the AAST based on ultrasound or CT.