Management of Liver Injuries Following Blunt Abdominal Trauma in Children

ABSTRACT

A clinical review was done in 31 children with blunt liver injury admitted to the Department of Surgery, Kyungpook National University hospital between 1981 and 1990. 17 of the 31 children with injured liver required laparotomy. (11 hepatorrhaphy, 4 lobectomy, 2 segmentectomy) There were two deaths after laparotomy, one from associated severe head injury and one from multi organ failure and the remaining 14 children, who were hemodynamically stable after initial resuscitation and without signs of other associated intraabdominal injuries, were managed by nonoperative treatment. Patients were observed in a pediatric intensive care unit for at least 48 hours with repeated abdominal physical examination, laboratory studies, vital sign check and bed rest. The hospital courses in all cases were uneventful and there were no late complication. A follow-up computed tomography was obtained in 7 patients, showing resolution of the injury in all. The authors believe that, for children with blunt liver injuries, nonoperative management is safe and appropriate if carried out under careful continuous surgical observation in a pediatric intensive care unit.