Abstract
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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Data Availability
Data will be available on request.
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Ethical approval was waived by the local Ethics Committee of Dow University of Health Sciences in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.
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Ali, S.W., Salim, A., Aslam, U. et al. Multidisciplinary management of high-grade pediatric liver injuries. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-023-02439-x
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DOI: https://doi.org/10.1007/s00068-023-02439-x