Abstract：
OBJECTIVE: To present our experience of multidisciplinary management of high-grade pediatric liver injuries.
BACKGROUND: 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.
CONCLUSIONS: 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.
BACKGROUND: 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.
CONCLUSIONS: 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.
摘要：
目的：介绍我们对儿科高度肝损伤的多学科管理的经验。
背景：由于相关的发病率和死亡率，小儿高度肝损伤对治疗提出了重大挑战。在这些患者中，控制出血和胆漏的急诊手术干预通常是次优的。在选定的高级别肝损伤的保守管理现在成为护理标准。由于假性动脉瘤形成和外伤性胆漏引起的胆道出血的管理需要多学科管理。
方法：在卡拉奇的两个三级护理中心对出现钝性肝损伤的患者进行了回顾性研究，巴基斯坦,从2021年3月到2022年12月。确认了28名患者，在此期间，有4例患者符合4级及以上钝性肝损伤的标准。
结果：1例4级肝损伤在损伤第7天出现胆道出血。他需要两种血管栓塞设置，但假性动脉瘤反复渗漏。他最终需要右肝动脉结扎。第二例患者在受伤后2天出现大量胆汁性腹膜炎。最初对他进行了管腹腔镜造口术，然后进行了ERCP和支架置入。第三例患者出现大腹膜，保守治疗。1例5级损伤在急诊手术中过期。
结论：晚期肝损伤的保守治疗可导致高并发症的发病率和死亡率。创伤外科医师需要有多学科团队来管理这些患者以获得最佳结果。
背景：由于相关的发病率和死亡率，小儿高度肝损伤对治疗提出了重大挑战。在这些患者中，控制出血和胆漏的急诊手术干预通常是次优的。在选定的高级别肝损伤的保守管理现在成为护理标准。由于假性动脉瘤形成和外伤性胆漏引起的胆道出血的管理需要多学科管理。
方法：在卡拉奇的两个三级护理中心对出现钝性肝损伤的患者进行了回顾性研究，巴基斯坦,从2021年3月到2022年12月。确认了28名患者，在此期间，有4例患者符合4级及以上钝性肝损伤的标准。
结果：1例4级肝损伤在损伤第7天出现胆道出血。他需要两种血管栓塞设置，但假性动脉瘤反复渗漏。他最终需要右肝动脉结扎。第二例患者在受伤后2天出现大量胆汁性腹膜炎。最初对他进行了管腹腔镜造口术，然后进行了ERCP和支架置入。第三例患者出现大腹膜，保守治疗。1例5级损伤在急诊手术中过期。
结论：晚期肝损伤的保守治疗可导致高并发症的发病率和死亡率。创伤外科医师需要有多学科团队来管理这些患者以获得最佳结果。
