Nonoperative management for major blunt hepatic trauma in a 3-year-old child

Abstract

Introduction: Based on hemodynamic stability, non-operative management of low- and high-grade liver injury is the first treatment choice over surgical treatment. Small clinics are still preferring primary operative approach instead of nonoperative one.

Presentation of the case: We are presenting a case (3-year-old male child) of nonoperative treatment of a grade IV blunt liver trauma (lacero-contusive injury of V, VI and VII segments) with massive hemoperitoneum. The patient was put into a conservative treatment with antibiotics, fluids and ½ unit of blood. The results of Computed Tomography showed significant amounts of perihepatic and periileal fluid between the bowels and in the Douglas pouch, which persisted for five days. Laboratory alterations ​​of Serum Glutamic Pyruvic Transaminase, Serum Glutamic-Oxaloacetic Transaminase, and Total Bilirubin reached their maximum values on third day, persisting in decline until fifth day and returned to normal after tenth day. The hospital stay was 11 days, the length of time necessary for the complete conservatory treatment and full recovery of the trauma.

Discussion: More than 80%-90% of liver injuries are managed with nonoperative intervention. Early and late complication can be managed by interventional radiology procedures when it is possible. Success rate of conservative treatment is over 80%.

Conclusion: If no other abdominal injuries are evident and patient is hemodynamically stable nonoperative management for major blunt hepatic trauma in children is the best choice of treatment