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Multidisciplinary management of high-grade pediatric liver injuries
Syed Waqas Ali1, Areej Salim2, Uzair Aslam3
1Department of Pediatric Surgery, Dow University of Health Sciences, Karachi, Pakistan.
Insights
High-grade pediatric liver injuries present management challenges. Multidisciplinary care is crucial for optimal outcomes in these complex cases, despite potential for significant morbidity and mortality with conservative approaches.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Hepatobiliary Surgery
Background:
- High-grade pediatric liver injuries are challenging due to high morbidity and mortality.
- Emergency surgery for hemorrhage and biliary leaks is often suboptimal.
- Conservative management is increasingly adopted, but requires careful multidisciplinary oversight.
Purpose of the Study:
- To present experience with multidisciplinary management of high-grade pediatric liver injuries.
- To highlight challenges in managing hemobilia and traumatic bile leaks in children.
Main Methods:
- Retrospective review of pediatric blunt liver injuries at two tertiary centers (March 2021 - December 2022).
- Analysis of four patients with grade 4 and above blunt liver injury.
Main Results:
- One grade 4 injury with hemobilia required angioembolization and hepatic artery ligation.
- Another patient with biliary peritonitis underwent tube laparostomy and ERCP with stent placement.
- One case of hemoperitoneum was managed conservatively; one grade 5 injury expired during surgery.
Conclusions:
- Conservative management of severe liver injuries carries risks of significant morbidity and mortality.
- A multidisciplinary team approach is essential for optimal outcomes in pediatric high-grade liver injuries.
Objective:
To present our experience of multidisciplinary management of high-grade pediatric liver injuries.
Introduction:
Pediatric high-grade liver injuries pose significant challenge to management due to associated morbidity and mortality. Emergency surgical intervention to control hemorrhage and biliary leak in these patients is usually suboptimal. Conservative management in selected high-grade liver injuries is now becoming standard of care. Management of hemobilia due to pseudoaneurysm formation and traumatic bile leaks requires multidisciplinary management.
Methods:
A retrospective review was undertaken for patients presenting with blunt liver injuries at two tertiary care centers in Karachi, Pakistan, from March 2021 to December 2022. Twenty-eight patients were identified, and four patients fulfilled the criteria for grade 4 and above blunt liver injury during this period.
Results:
One case with grade 4 liver injury developed hemobilia on 7th day of injury. He required two settings of angioembolization but had recurrent leak from pseudoaneurysm. He ultimately needed right hepatic artery ligation. Second patient presented with massive biliary peritonitis 2 days following injury. He was managed initially with tube laparostomy followed by ERCP and stent placement. The third patient developed large hemoperitoneum managed conservatively. One case with grade 5 injury expired during emergency surgery.
Conclusion:
Conservative management of advanced liver injuries can result in significant morbidity and mortality due to high risk of complications. Trauma surgeons need to have multidisciplinary team for management of these patients to gain optimal outcome.
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