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Outcomes and indications for intervention in non-operative management of paediatric liver trauma: a 5 year
Insights
Non-operative management using computed tomography (CT) evaluation and embolization is effective for paediatric liver trauma. This approach shows a high success rate in children, potentially exceeding that in adults.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Radiology
Background:
- Liver trauma in children presents unique management challenges.
- Accurate diagnostic imaging is crucial for guiding treatment decisions.
- Non-operative management strategies are increasingly explored for pediatric injuries.
Purpose of the Study:
- To assess the feasibility and success of computed tomography (CT) evaluation and embolization for non-operative management of liver trauma in children.
- To determine the applicability of these techniques in a pediatric population.
Main Methods:
- Retrospective observational study of 37 children with hepatic trauma.
- All patients underwent CT evaluation and received an Association for the Surgery of Trauma score.
- Management strategies, efficacy, complications, and outcomes were reviewed.
Main Results:
- The study included various grades of liver lacerations and contusions.
- All pediatric patients with liver trauma were managed non-operatively.
- Angiography and embolization were employed for active bleeding and pseudoaneurysms, with successful outcomes and minimal complications.
- Endoscopic retrograde cholangiopancreatography (ERCP) with stenting addressed bile leaks.
Conclusions:
- Computed tomography (CT) evaluation and embolization are applicable and effective for non-operative management of pediatric liver trauma.
- Non-operative management may achieve higher success rates in children compared to adults.
Aim:
To determine the applicability of accurate computed tomography (CT) evaluation and embolization as non-operative management for liver trauma in a paediatric population.
Material And Methods:
A retrospective observational study of 37 children (mean age 10.5 years) with hepatic trauma (28 blunt, 9 penetrating) admitted to a trauma referral centre over a 5 year period. All patients were evaluated with CT and scored with an Association for the Surgery of Trauma score. Inpatient information was reviewed for demographics, associated injuries, modes of management, efficacy and complications of management, and outcome.Statistical analysis was performed.
Results:
There were seven contusions, two grade I, two grade II, nine grade III, and 17 grade IV liver lacerations. Only two patients (grade IV, penetrating) underwent surgery for the management of bowel perforation. All children had non-surgical treatment of their liver trauma: three cases (grade IV) had primary angiography due to CT evidence of active bleeding and embolization was performed in two of these. Seven patients (two grade III, five grade IV)had angiography during the follow-up for evidence of a complicating pseudoaneurysm and embolization was performed in six of them. Embolization was successful in all the children; one minor complication occurred (cholecystitis). Endoscopic retrograde cholangiopancreatography (ERCP) plus stenting was performed in two cases for a bile leak. All 37 children had a positive outcome.
Conclusion:
The present study demonstrates that non-operative management of hepatic trauma is applicable to children and may have a higher success rate than in adults.
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