Post on 02-Oct-2021
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= 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).
6. ~~ transaminase ?~I
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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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