tH A( oLA~ ¢. 01 -'L..!Oc> 12

= Abstract =

Management of Liver Injuries Following Blunt Abdominal Trauma in Children

Jin Young Park, M.D., Sooil Chang, M.D.

Department of Surgery, Kyungpook National University School of Medicine

Taegu, Korea

A clinical review was done of 31 children with blunt liver injury who were admitted to the Department of Surgery, Kyungpook National University Hospital

,

between 1981 and 1990. Seventeen of the 31 children required laparotomy(ll pri-mary repairs, 4 lobectomies, 2 segmentectomies). There were two deaths after laparotomy, one due to associated severe head injury and another due to multiorgan failure. The remaining 14 children, who were hemodynamically stable after initial resuscitation and who did not have signs of other associated intraabdominal injuries, were managed by nonoperative treatment. Patients were observed in a pediatric intensive care unit for at least 48 hours with repeated abdominal clinical evaluations, laboratory studies, and monitoring of vital signs. The hospital courses in all cases were uneventful and there were no late compli­cation. A follow-up computed tomography of 7 patients showed resolution of the injury in all. The authors believe that, for children with blunt liver injuries, nonoperative management is safe and appropriate if carried out under careful continuous surgical observation in a pediatric intensive care unit.

Index Words: Nonoperative management, Blunt liveT injuTy

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Table 1. Symptoms

Symptoms No. of cases (%)

Abdominal pain 27 (87 %)

Vomiting 6 (19 %)

Dyspnea 4 (12 %)

Chest pain 2 ( 6%)

Shoulder radiating pain 1 ( 3 %)

Back pain 1 ( 3 %)

Dizziness 1 ( 3 %)

Hematemesis 1 ( 3 %)

Syncope 1 ( 3 %) •

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Table 2. Physical Findings

Physical Findings

Abdominal tenderness

Abdominal distension

Muscle guarding

Rebound tenderness

No. of cases (%)

22 (71 %)

19 (61%)

8 (26%)

8 (26%)

Upper abdomen or lower chest contusion, abrasion 7 (23%)

Table 3. Associated Injuries

Associated Operative Non-operative • • • (n = 17 ) (n 14 ) InJunes

Musculoskeletal 8 7

Chest 6 1

Central nerve system 2 3

Genitourinary 5 0

Gastrointestinal 3 0

Spleen 0 3

Major blood vessel 2 0

01 3).

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Table 4. Serum Transaminase

Liver

enzyme

SGOT > 200 < 200

SGPT > 100 < 100

Operative (n = 15)

7 8

12 3

•

Non-operative (n = 11)

6 5

7 4

- 34-

Table 5. Scaling of Liver Injury by Moore

Grade Injury description

I

II

III

IV

V

Capsular avulsion or laceration < 1 em

Fracture 1 - 3 em, hematoma < 10 em, or peripheral penetrating wound

Fracture> 3 em, hematoma > 10 em, or central penetrating wound

Lobar destruction or massive central hematoma

Extensive bilobar disruption or inferior vena cava injury

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Table 6. Prevalence of the Liver Injury by Moore Classification

Liver injury Operative Non-operative Total ( %) grade (n 8) (n 12)

I 1 9 10 ( 50 )

II 3 1 4 ( 20 )

III 2 2 ( 10 )

IV 4 4 ( 20 )

V

- 35 -

Table 7. Outcome

Outcome Operative

Survival

Complication

Death

( n = 17 )

15 (88 %)

9 (53 %)

2 ( 1 %)

Non-operative

(n = 14 )

14 (100 %)

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