Management of paediatric liver trauma

Pediatr Surg Int. 2017 Apr;33(4):445-453. doi: 10.1007/s00383-016-4046-3. Epub 2016 Dec 27.


Of all the intra-abdominal solid organs, the liver is the most vulnerable to blunt abdominal trauma. The majority of liver ruptures present in combination with other abdominal or extra-abdominal injuries. Over the last three decades, the management of blunt liver trauma has evolved from obligatory operative to non-operative management in over 90% of cases. Penetrating liver injuries more often require operative intervention and are managed according to adult protocols. The greatest clinical challenge remains the timely identification of the severely damaged liver with immediate and aggressive resuscitation and expedition to laparotomy. The operative management can be taxing and should ideally be performed in a dedicated paediatric surgical centre with experience in dealing with such trauma. Complications can occur early or late and include haemobilia, intrahepatic duct rupture with persistent biliary fistula, bilaemia, intrahepatic haematoma, post-traumatic cysts, vascular outflow obstruction, and gallstones. The prognosis is generally excellent.

Keywords: Children; Liver; Trauma.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Bile Ducts, Intrahepatic / injuries
  • Cholecystitis / etiology
  • Cholecystitis / therapy
  • Conservative Treatment
  • Cysts / etiology
  • Cysts / therapy
  • Gallstones / etiology
  • Gallstones / therapy
  • Hematoma / etiology
  • Hematoma / therapy
  • Hemobilia / etiology
  • Hemobilia / therapy
  • Hemorrhage / etiology
  • Hemorrhage / surgery
  • Hepatic Veno-Occlusive Disease / etiology
  • Hepatic Veno-Occlusive Disease / therapy
  • Humans
  • Liver / injuries*
  • Liver / surgery*
  • Rupture / etiology
  • Wounds and Injuries / classification
  • Wounds and Injuries / complications
  • Wounds and Injuries / therapy