Conservative management of liver trauma and its complications: current gold-standard

• Published in: Cirugía pediátrica Vol. 29; no. 1; pp. 19 - 24
• Main Authors: Gander, R, Molino, J A, Santiago, S, Laín, A, Guillén, G, Giné, C, Royo, G, López, S, Pérez, M, Díez, I, Cañadas, S, Lloret, J, Bueno, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 25-01-2016
• Subjects: Hepatic blunt trauma; Paediatric; Interventional radiology; Abdominal injury; Trauma
• ISSN: 0214-1221

The liver is the second most frequently involved organ in abdominal trauma in children. The aim of this study was to review the characteristics of liver traumas (LT) in children, its treatment and complications.
Retrospective study of patients with LT treated between 2010-2014. We analyzed data regarding diagnosis, conservative management (CM), complications and treatment.
Twenty-four patients of LT with a mean age of 9.8 years (SD: 3.4) were treated at our center. Liver injury degrees according to the Organ Injury Scale of American Association for Surgery of Trauma (AAST) were: grade I (4), grade II (6), grade III (8), grade IV (5) and grade V (1). CT angiography was performed in 23 patients. Four of the six patients with initial hemodynamic instability required blood transfusion; of those, two required angioembolization for active bleeding in extrahepatic locations and a third required damage control surgery. Three patients presented late-onset complications: 2 large size bilomas which underwent spontaneous resolution and a third patient with a right biloma and section of the left bile duct who required a multidisciplinary approach. Median hospital stay was 6 days (r 1-92). With a mean follow-up of 17.75 months (SD: 16.35) (r: 2-57) long-term survival was 96%. The patient who received surgery died due to a post-traumatic brain injury.
CM seems to be the treatment of choice in LT regardless of injury degree. Surgery should be reserved for cases refractory to CM due to the associated high mortality.