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Liver injuries in children: the role of selective non-operative management
A Landau1, A B van As, A Numanoglu
1Trauma Unit, Department of Pediatric Surgery, Red Cross Children's Hospital, University of Cape Town, Cape Town, Rondebosch 7701, South Africa.
Insights
Non-operative management is highly successful for pediatric blunt liver trauma, with 93% of patients treated successfully without surgery. This approach reduces complications, transfusion needs, and hospital stays for children with liver injuries.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Hepatobiliary Surgery
Background:
- Blunt liver trauma in children presents significant management challenges.
- This review analyzes 22 years of experience with 311 pediatric patients.
Purpose of the Study:
- To evaluate the effectiveness of non-operative management for blunt liver injuries in children.
- To identify factors influencing outcomes in pediatric blunt liver trauma.
Main Methods:
- Retrospective analysis of 311 pediatric patients with confirmed blunt liver trauma.
- Data collected included clinical presentation, injury grade, associated injuries, and treatment outcomes.
Main Results:
- Motor vehicle accidents were the most common cause (86%).
- 93% of patients were successfully treated non-operatively.
- Complication rate was 8% and overall mortality was 1%.
Conclusions:
- Selective non-operative management is a proven and effective treatment for pediatric blunt liver trauma.
- Early identification of severely injured children and timely laparotomy are crucial.
- This approach leads to lower complication rates, reduced transfusions, and shorter hospital stays.
Introduction:
This review article on the management of blunt liver injury in children is based on the authors' experience of 311 patients over a 22-year period.
Material And Methods:
All children presenting to our institution with confirmed blunt liver trauma were studied retrospectively. Hospital folders of 311 patients were analysed. Information was gathered about the clinical presentation, associated injuries, grade of injury, transfusion requirements and haemodynamic stability to examine factors influencing outcome.
Results:
The age of patients ranged between 3 weeks and 12 years (mean of 7 years). Injuries as a result of motor vehicle accidents (MVAs) were the most common (268; 232 pedestrian and 36 passenger), other causes were falls (26) assaults or child abuse(15), bicycle handle bar injury (2). One hundred and thirty-six patients sustained an isolated hepatic injury and 175 had multiple injuries. Associated injuries included 147 head injuries, 131 fractures, 66 thoracic and 143 intra-abdominal (74 spleen, 45 renal, 4 pancreatic and 4 hollow viscus). Two patients died soon after arrival, 21 underwent laparotomy, 13 of which were liver related, while 288 were treated non-operatively. One hundred and six patients required blood transfusion (mean of 21.3 ml/kg); 30% of the nonoperative group and 100% of the operative group. There were three fatalities from the operative group (1% total mortality), one secondary to a severe, head injury, one liver haemorrhage and one from multi-organ failure
Discussion:
The vast majority (93%) was successfully treated non-operatively with only 4% coming to liver related laparotomy, complications were lower, transfusions less and the in-hospital occupancy was shorter. Complication rate was 8% and mortality was 1%.
Conclusion:
We confirm the success selective non-operative management of blunt liver trauma as adopted by this institution 20 years ago. It is now proven treatment in an appropriate centre. However, the challenge is to identify the severely injured child early and institute aggressive resuscitation and expedite laparotomy when indicated.
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