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Published on: August 8, 2025
Management of paediatric liver trauma
A B van As1, Alastair J W Millar2
1Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Insights
Blunt liver trauma management has shifted to non-operative approaches in over 90% of cases. Timely identification and resuscitation are crucial for severe liver injuries, with excellent overall prognosis.
Area of Science:
- Trauma Surgery
- Hepatobiliary Surgery
- Pediatric Surgery
Background:
- The liver is the most vulnerable intra-abdominal solid organ to blunt trauma.
- Liver injuries often occur with other abdominal or extra-abdominal injuries.
- Management has evolved significantly over 30 years.
Purpose of the Study:
- To review the evolving management of blunt liver trauma.
- To highlight challenges in identifying and managing severe liver injuries.
- To discuss potential complications and prognosis.
Main Methods:
- Review of management strategies for blunt liver trauma over three decades.
- Discussion of operative vs. non-operative approaches.
- Emphasis on timely resuscitation and surgical intervention when necessary.
Main Results:
- Non-operative management is now successful in over 90% of blunt liver trauma cases.
- Penetrating liver injuries typically require operative intervention.
- Severe liver damage necessitates immediate resuscitation and potential laparotomy.
Conclusions:
- The management of blunt liver trauma has largely shifted to non-operative strategies.
- Prompt identification and resuscitation are critical for severe injuries.
- Despite potential complications, the prognosis for liver trauma is generally excellent.
Abstract:
Of all the intra-abdominal solid organs, the liver is the most vulnerable to blunt abdominal trauma. The majority of liver ruptures present in combination with other abdominal or extra-abdominal injuries. Over the last three decades, the management of blunt liver trauma has evolved from obligatory operative to non-operative management in over 90% of cases. Penetrating liver injuries more often require operative intervention and are managed according to adult protocols. The greatest clinical challenge remains the timely identification of the severely damaged liver with immediate and aggressive resuscitation and expedition to laparotomy. The operative management can be taxing and should ideally be performed in a dedicated paediatric surgical centre with experience in dealing with such trauma. Complications can occur early or late and include haemobilia, intrahepatic duct rupture with persistent biliary fistula, bilaemia, intrahepatic haematoma, post-traumatic cysts, vascular outflow obstruction, and gallstones. The prognosis is generally excellent.
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