Multidisciplinary management of high-grade pediatric liver injuries

Authors

Syed Waqas Ali, Dow University of Health Sciences, Pakistan
Areej Saleem, Aga Khan UniversityFollow
Uzair Aslam, Dow University of Health Sciences, Pakistan
Saad Khalid, Dow University of Health Sciences, Pakistan
Muhammad Sajjad Ashraf, Dow University of Health Sciences, Pakistan
Muhammad Arif Mateen Khan, Aga Khan UniversityFollow

Document Type

Article

Department

Paediatric Surgery

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.

Comments

Volume, issue and pagination are not provided by the author/publisher

Publication (Name of Journal)

European Journal of Trauma and Emergency Surgery

DOI

https://doi.org/10.1007/s00068-023-02439-x

Recommended Citation

Ali, S. W., Saleem, A., Aslam, U., Khalid, S., Ashraf, M. S., Khan, M. (2024). Multidisciplinary management of high-grade pediatric liver injuries. European Journal of Trauma and Emergency Surgery.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr/200