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Complications after conservative treatment of blunt liver trauma in children
C de Magnée1, D Forgues, G Mercier
1Division of Paediatric Surgery, Lapeyronie University Hospital, Montpellier, France. catherine.demagnee@uclouvain.be
Insights
Conservative treatment for blunt liver trauma (BLT) in children is effective, with a 94.1% success rate. Hepatic complications are uncommon and often manageable with minimally invasive techniques.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Hepatobiliary Surgery
Background:
- Nonoperative management is the standard for hemodynamically stable children with blunt liver trauma (BLT).
- Evaluating complications of conservative BLT treatment is crucial for optimizing patient care.
Purpose of the Study:
- To assess the incidence, risk factors, presentation, diagnosis, management, and outcomes of hepatic complications following nonoperative treatment of BLT in children.
Main Methods:
- Retrospective analysis of pediatric patients with BLT treated nonoperatively at a single center over 10 years.
- Inclusion criteria: hemodynamically stable children with BLT managed conservatively.
Main Results:
- 94.1% success rate for nonoperative BLT management in 51 children.
- 5.9% of patients (grade 3+ lesions) developed 13 hepatic complications, often predicted by hemodynamic instability, peritoneal signs, or significant blood loss.
- Complications appeared a median of 19 days post-injury and were treated with minimally invasive (69.2%) or surgical (30.8%) methods.
Conclusions:
- Conservative management of BLT in hemodynamically stable children is validated.
- Hepatic complications are infrequent and frequently treatable with minimally invasive approaches, leading to favorable outcomes.
Background:
Nonoperative treatment is the gold standard approach to treat blunt liver trauma (BLT) in hemodynamically stable children. The purpose of this study was to evaluate the incidence, risk factors, timing for appearance, diagnostic modalities, management and outcome of hepatic complications secondary to such approach.
Methods:
This retrospective study included children admitted at Montpellier University Hospital for BLT over a 10-year period. All hemodynamically stable children were initially conservatively treated.
Results:
A total of 51 children underwent nonoperative treatment for BLT during the study period. The success rate was 94.1% (48/51). Three patients (5.9%) presented 13 complications related to hepatic injuries and required secondary surgical treatment. These 3 patients presented grade 3 or higher liver lesions. Others factors identified as predictive of complications included initial hemodynamic instability (responding to the first resuscitative measures), presence of peritoneal irritation at first examination, severe hemoperitoneum, an initially low haemoglobin level (< 8.5 g/dl) and need for important transfusions during the first 48h (> 10 cc/kg). The median interval for appearance of complications was 19 days after injury (range 1-60 days). Complications were successfully treated using minimally invasive techniques in 69.2% of cases (9/13). The rest of the complications (30.8% : 4/13) were surgically treated. All children included in our study had favourable outcomes (follow-up 1-54 months).
Conclusions:
This series fully validates conservative approach of BLT in hemodynamically stable children. Complications of such approach are uncommon; many can be successfully treated using minimally invasive techniques with very satisfying results.
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