Pulmonary embolism in two patients after severe hepatic trauma

Area of Science:

• Pediatric Surgery
• Vascular Surgery
• Critical Care Medicine

Background:

• Severe hepatic trauma necessitates damage control laparotomy and perihepatic packing, increasing venous thromboembolism (VTE) risk.
• Existing VTE prevention and treatment guidelines are often extrapolated from adult data, posing challenges for pediatric patients.
• Pediatric VTE management after major abdominal surgery requires specialized consideration.

Observation:

• This case report details two pediatric patients who developed VTE, including pulmonary embolism, post-hepatic trauma surgery.
• One patient experienced hemodynamically significant pulmonary emboli, treated successfully with catheter-directed thrombolysis.
• The second patient presented with a vena caval thrombus and subsequent pulmonary embolism, managed with anticoagulation.

Findings:

• Catheter-directed thrombolysis demonstrated efficacy in improving respiratory and hemodynamic status in a pediatric patient with severe pulmonary embolism.
• Surveillance imaging identified VTE, enabling timely intervention and resource allocation.
• Anticoagulation with heparin and enoxaparin was effective for managing vena caval and pulmonary thrombi in the second patient.

Implications:

• Proactive surveillance imaging in pediatric hepatic trauma patients can facilitate the timely mobilization of critical resources like interventional radiology.
• Catheter-directed thrombolysis emerges as a potentially viable and effective treatment for life-threatening VTE in critically ill pediatric surgical patients.
• This experience underscores the need for tailored VTE management strategies in pediatric trauma care.