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Pulmonary embolism in two patients after severe hepatic trauma. J Pediatr Intensive Care 2013 Sep;2(3):127-130

Date

09/01/2013

Pubmed ID

31214434

Pubmed Central ID

PMC6530726

DOI

10.3233/PIC-13061

Scopus ID

2-s2.0-85013613006   1 Citation

Abstract

Patients with severe hepatic trauma requiring damage control laparotomy and perihepatic packing are at risk for venous thromboembolism (VTE). Prevention and treatment of VTE in this population is problematic, especially in children for whom adult guidelines are often adapted. The following case report describes two children who developed VTE with associated pulmonary embolism after damage control laparotomy and perihepatic packing for hepatic trauma. The first patient had hemodynamically significant pulmonary emboli. He received catheter-directed thrombolysis with subsequent improvement in ventilation and need for inotropic support. The second patient had a vena caval thrombus detected on surveillance ultrasound and later developed a pulmonary embolus, both of which were treated with heparin and enoxaparin. Our experience suggests that surveillance imaging of these patients may allow for prospective mobilization of specialized resources, such as interventional radiology support or cardiopulmonary bypass equipment, and that catheter-directed thrombolysis may be a viable treatment modality in these critically ill and injured children.

Author List

Claveria JK, Meyer MT, Wakeham MK, Sato TT

Authors

Michael T. Meyer MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Martin K. Wakeham MD Professor in the Pediatrics department at Medical College of Wisconsin