The nonoperative management of pediatric hepatic trauma

Although nonoperative therapy is well-accepted for renal and splenic injuries in children, this mode of treatment has not been widely advocated for children with blunt hepatic injury. Surgical repair or excision of the traumatized tissue has been the generally accepted standard of care. In the present series, 17 consecutive children between 2 and 13 years of age with liver trauma were managed by nonoperative means. Patients were carefully selected for treatment based on clinical criteria and initial computed tomography (CT) scan findings. The 17 patients with hepatic trauma identified by CT scan all responded to initial resuscitative measures. The children clinically remained stable and required only a limited number of transfusions. No immediate surgical intervention was necessary for isolated hepatic injuries. However, one patient required exploration due to an associated renal pedicle avulsion. One child required exploration on the fourth post-injury day because of a suspected infected hematoma. The remaining 15 injuries resolved without operation. Healing was documented on follow-up CT scans. The mean time required for resolution of the injury was 4 months. One child developed a late subhepatic hematoma which resolved without drainage. The progression of healing of hepatic parenchymal injuries was observed by serial CT scans. The liver injury progressed through stages of coalescence, resorption, and remodeling prior to final healing. Utilizing proper patient selection, many blunt liver injuries can be managed nonoperatively.