Infant Caudate Lobe Injury With Retroperitoneal Hematoma: A Case Report

Liver injury, especially caudate lobe injury, is an extremely rare form of injury in infants. In most cases, liver injury results in intraperitoneal hemorrhage when the capsule is ruptured, and circulatory dynamics deteriorate early. Caudate lobe injuries, however, often present with a high retroperitoneal hematoma. The diagnosis is difficult to identify with a focused assessment with sonography for trauma (FAST) in the initial treatment of trauma and may even be delayed without contrast-enhanced CT imaging. A one-month-old postoperative boy with congenital heart disease was involved in a motor vehicle accident and presented with a single caudate lobe injury. He was not wearing a seatbelt, and it was thought that the caudate lobe was injured due to shearing forces in the cephalocaudal direction at the time of the accident. The patient did not go into shock when he first came to our hospital, but a few hours after admission, he went into shock and required surgical hemostasis. The postoperative course was good, and the patient was discharged alive one month later. The lesson to be learned from this case is that caudate lobe injuries are often associated with retroperitoneal hematoma and slow deterioration of hemodynamics, so it is important not to miss small changes in the child's vitals and to be willing to perform contrast-enhanced CT imaging depending on the type of injury.