Management of paediatric liver trauma

Of all the intra-abdominal solid organs, the liver is the most vulnerable to blunt abdominal trauma. The majority of liver ruptures present in combination with other abdominal or extra-abdominal injuries. Over the last three decades, the management of blunt liver trauma has evolved from obligatory o...

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Bibliographic Details
Published in:Pediatric surgery international 2017-04, Vol.33 (4), p.445-453
Main Authors: van As, A. B., Millar, Alastair J. W.
Format: Article
Language:English
Subjects:
Algorithms
Bile Ducts, Intrahepatic - injuries
Cholecystitis - etiology
Cholecystitis - therapy
Conservative Treatment
Cysts - etiology
Cysts - therapy
Gallstones - etiology
Gallstones - therapy
Hematoma - etiology
Hematoma - therapy
Hemobilia - etiology
Hemobilia - therapy
Hemorrhage - etiology
Hemorrhage - surgery
Hepatic Veno-Occlusive Disease - etiology
Hepatic Veno-Occlusive Disease - therapy
Humans
Liver - injuries
Liver - surgery
Medicine
Medicine & Public Health
Pediatric Surgery
Pediatrics
Review Article
Rupture - etiology
Surgery
Wounds and Injuries - classification
Wounds and Injuries - complications
Wounds and Injuries - therapy
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Summary:Of all the intra-abdominal solid organs, the liver is the most vulnerable to blunt abdominal trauma. The majority of liver ruptures present in combination with other abdominal or extra-abdominal injuries. Over the last three decades, the management of blunt liver trauma has evolved from obligatory operative to non-operative management in over 90% of cases. Penetrating liver injuries more often require operative intervention and are managed according to adult protocols. The greatest clinical challenge remains the timely identification of the severely damaged liver with immediate and aggressive resuscitation and expedition to laparotomy. The operative management can be taxing and should ideally be performed in a dedicated paediatric surgical centre with experience in dealing with such trauma. Complications can occur early or late and include haemobilia, intrahepatic duct rupture with persistent biliary fistula, bilaemia, intrahepatic haematoma, post-traumatic cysts, vascular outflow obstruction, and gallstones. The prognosis is generally excellent.
ISSN:0179-0358
1437-9813
DOI:10.1007/s00383-016-4046-3