Document Detail


Blunt liver injury in childhood: evolution of therapy and current perspective.
MedLine Citation:
PMID:  3738775     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
One hundred eighty-eight consecutive children with serious blunt abdominal or multisystem trauma were evaluated between August 1981 and July 1985. Of the 188 patients, 53 (28%) were found to have hepatic parenchymal injuries and are the basis of this report. Four of the 53 (8%) underwent emergency laparotomy for exsanguinating hemorrhage; two patients died, both of hepatic vein lacerations, and two are alive and well after right hepatic lobectomy. Forty-nine (92%) of the children with liver injuries did not require operation for hemorrhage. Four of these 49 patients developed serious complications; hemobilia occurred in one patient and bile peritonitis occurred in three. The one case of hemobilia was resolved without surgery. One child underwent a delayed operative biliary tract reconstruction that was successful. The other two children required a combination of debridement and drainage procedures. Fifty-one of the 53 children (96%) are currently alive without morbidity related to their liver injuries. Both children who died had multiple trauma including central nervous system injuries and had exsanguinating hemorrhage that required emergency laparotomy at initial evaluation. There were no children with "late" hemorrhage and none who developed septic complications. Nonoperative management of most childhood blunt abdominal trauma is possible. Widespread use of abdominal computerized tomography scanning has made this approach practical. This large series of consecutive liver injuries from a large pediatric trauma center illustrates the advantages and the risks of a selective but primarily nonoperative approach to liver trauma in children.
Authors:
K T Oldham; K S Guice; F Ryckman; R A Kaufman; L W Martin; J Noseworthy
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  100     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1986 Sep 
Date Detail:
Created Date:  1986-09-25     Completed Date:  1986-09-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  542-9     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Alanine Transaminase / blood
Aspartate Aminotransferases / blood
Biliary Tract / injuries
Child
Hemorrhage / etiology
Humans
Laparotomy
Liver / injuries*,  radiography
Peritonitis / etiology
Retrospective Studies
Tomography, X-Ray Computed
Wounds, Nonpenetrating / mortality,  radiography,  therapy*
Chemical
Reg. No./Substance:
EC 2.6.1.1/Aspartate Aminotransferases; EC 2.6.1.2/Alanine Transaminase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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