Liver injuries in children: the role of selective non-operative management.

Background: Trauma remains the leading cause of mortality in the pediatric population. Liver injuries occur commonly in blunt abdominal trauma.

Aim: To assess the selective non-operative management of liver injuries in children.

Methods: A retrospective review of 51 patients with a discharge diagnosis of traumatic liver injuries at Tunis Children's Hospital, over a 14-year period from 1996 to 2009.

Results: We identified 51 patients with liver trauma. The median age was 7 years. Boys accounted for 58% (n= 30), and the most common cause was traffic accident. Head injuries were the most common associated injuries. Forty-nine patients (96%) required non-operative management without complications. The mean in-hospital stay was 10 days in this group. The ultrasound demonstrated complete resolution and healing after 3-6 months. Two patients underwent surgery for hemodynamic instability. The mortality rate was 0.2 %.

Conclusion: Safe, non-operative management involves careful serial examination, a CT scanning facility and close monitoring of the patient in a fully equipped high-dependency unit with trained staff to run it. Even though most patients can be treated non-operatively the challenge is to identify the severely injured child early and institute aggressive resuscitation and expedite laparotomy.