Factors for failure of nonoperative management of blunt hepatosplenic trauma in children

Abstract

Background Trauma is major cause of morbidity and mortality in children with blunt abdominal trauma; the most commonly injured organs are the liver and the spleen. A high rate of operative complications caused a shift from operative to nonoperative management (NOM) in patients suffering from hemodynamically stable blunt abdominal trauma. The aim is to evaluate factors for failure of NOM for blunt abdominal trauma that caused injuries of the liver and the spleen in children.
Patients and methods This study included 142 patients with blunt abdominal trauma with either hepatic or splenic injuries that were hemodynamically stable and treated initially by NOM. Patients had undergone a contrast computed tomography (CT) scan for grading injuries, contrast blush, and hemoperitoneum.
Results There were 17 patients with high-grade hepatic or splenic injury. Six of these 17 patients and two patients with low-grade injuries failed NOM. Moderate and large volumes of hemoperitoneum have been reported in 42 and nine patients, respectively, with failure rates of 7.1 and 44.4%. Fourteen patients had CT blush on CT scan; five of them failed NOM (failure rate of 35.7%). Two other patients needed laparotomy for intestinal injuries. Thus, the overall success rate of NOM was 93% (132 patients); 10 (7%) patients failed NOM.
Conclusion High-grade injuries, large hemoperitoneum, and contrast blush on the CT scan increase the risk of failure of NOM in patients with blunt hepatosplenic injuries. Nevertheless, most of these patients can be successfully managed with NOM. However, other than hemodynamic instability, the other factors mentioned above deserve further evaluation to determine their ability to aid in the decision between operative and NOM for blunt hepatosplenic injuries in children.

Keywords: hepatosplenic injury, nonoperative, blunt