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Management of liver trauma in children
Insights
Emergency laparotomy for acute liver injury in children can be managed effectively. Packing liver wounds with omentum reduced the need for resection and improved survival rates, lowering overall mortality.
Area of Science:
- Pediatric surgery
- Hepatobiliary surgery
- Trauma surgery
Background:
- Acute liver injury in children often necessitates emergency laparotomy.
- Massive hemorrhage from hepatic veins was a significant challenge, historically requiring liver resection.
Purpose of the Study:
- To review management strategies for acute liver injury in pediatric patients undergoing emergency laparotomy.
- To evaluate the impact of different surgical techniques on outcomes, particularly hemorrhage control and mortality.
Main Methods:
- Retrospective review of 203 children's charts undergoing emergency laparotomy for acute liver injury.
- Analysis of surgical interventions, including drainage, liver resection, and omental packing for hemorrhage control.
Main Results:
- Majority of cases required only drainage.
- Liver resection was performed in 17 children with an 18% mortality rate in earlier years.
- Omental packing for bleeding control significantly reduced the need for resection and fatalities from hemorrhage.
- Overall mortality was 6%, with complications including sepsis and hemobilia.
Conclusions:
- Omental packing is an effective technique for controlling massive hemorrhage in pediatric liver trauma, reducing the need for liver resection.
- Improved surgical management has decreased mortality associated with acute liver injury in children.
- Continued vigilance for associated injuries and postoperative complications is crucial.
Abstract:
The charts of 203 consecutive children undergoing emergency laparotomy for management of an acute liver injury were reviewed. Although drainage was all that was required in the majority of cases, massive hemorrhage, usually arising from disrupted hepatic veins, appeared to demand liver resection (as performed in 17 children, with a mortality of 18%) during earlier years of the survey. Control of exsanguinating bleeding from such liver wounds by packing with viable autogenous tissue (pedicled omentum) subsequently eliminated almost entirely the need for resection. Fatalities resulting from either hemorrhagic shock or loss of liver substance then became relatively rare. Additional significant problems were associated organ injuries, postoperative wound and intra-abdominal sepsis, bleeding diatheses, and late instances of hemobilia. The overall mortality was 6%.