Blunt liver injury in childhood: evolution of therapy and current perspective. Surgery 1986 Sep;100(3):542-9
Date
09/01/1986Pubmed ID
3738775Scopus ID
2-s2.0-0022467382 (requires institutional sign-in at Scopus site) 123 CitationsAbstract
One hundred eighty-eight consecutive children with serious blunt abdominal or multisystem trauma were evaluated between August 1981 and July 1985. Of the 188 patients, 53 (28%) were found to have hepatic parenchymal injuries and are the basis of this report. Four of the 53 (8%) underwent emergency laparotomy for exsanguinating hemorrhage; two patients died, both of hepatic vein lacerations, and two are alive and well after right hepatic lobectomy. Forty-nine (92%) of the children with liver injuries did not require operation for hemorrhage. Four of these 49 patients developed serious complications; hemobilia occurred in one patient and bile peritonitis occurred in three. The one case of hemobilia was resolved without surgery. One child underwent a delayed operative biliary tract reconstruction that was successful. The other two children required a combination of debridement and drainage procedures. Fifty-one of the 53 children (96%) are currently alive without morbidity related to their liver injuries. Both children who died had multiple trauma including central nervous system injuries and had exsanguinating hemorrhage that required emergency laparotomy at initial evaluation. There were no children with "late" hemorrhage and none who developed septic complications. Nonoperative management of most childhood blunt abdominal trauma is possible. Widespread use of abdominal computerized tomography scanning has made this approach practical. This large series of consecutive liver injuries from a large pediatric trauma center illustrates the advantages and the risks of a selective but primarily nonoperative approach to liver trauma in children.
Author List
Oldham KT, Guice KS, Ryckman F, Kaufman RA, Martin LW, Noseworthy JAuthor
Keith Oldham MD Emeritus Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Alanine TransaminaseAspartate Aminotransferases
Biliary Tract
Child
Hemorrhage
Humans
Laparotomy
Liver
Peritonitis
Retrospective Studies
Tomography, X-Ray Computed
Wounds, Nonpenetrating
