MANAGEMENT OF BLUNT LIVER TRAUMA IN CHILDREN

Introduction Management of liver trauma in childhood represents a rare but formidable challenge. Methods Clinical presentation, grade of liv er injury and Injury Severity Score (ISS) were studied in 11 cases of blunt liver trauma to examine factors influencing outcome. Results Sev en of the 11 children were injured severely and had an ISS greater tha n 16. Seven who were haemodynamically stable were treated without oper ation, but four required surgery for grade III, IV and V liver injurie s. Two children had primary repair of hepatic lacerations. Perihepatic packing was employed in two other cases (grade IV and V injury) for u ncontrollable haemorrhage. Delayed debridement and thrombectomy plus v ena cava repair with suturing of liver lacerations in these patients o bviated heroic efforts at primary repair. Nine children survived. Ther e were two deaths from head and neck trauma. Discussion Selected child ren with liver trauma can be managed non-operatively using established trauma guidelines. Perihepatic packing is recommended in unstable pat ients with complex injuries, followed by delayed definitive repair.