Successful nonsurgical management of major liver trauma in a 2 year old child: A case report

Background: Management of blunt abdominal injuries involving liver is largely being replaced by non-operative modalities, surgery being reserved only for high grades of liver tears in a hemodynamically unstable patient. We here present the case of a two year old chid with a grade 4 liver lacerations successfully managed without surgery at our centre. Case summary: A two year old male child presented to the emergency with a history of trivial blunt abdominal trauma followed by progressively increasing pain abdomen and giddiness. He was found to be hypovolemic shock at arrival. He was investigated after adequate resuscitation. He had no signs of external injury or peritonism at the time of presentation. Next 12 hours showed progressive fall in haematocrit inspite of blood replacement. CT angiogram was performed which showed grade 4 liver lacerations involving segments 7, 8, 6 and adjacent 4a and caudate lobe with contrast extravasation from the posterior sectoral branch of RHA. Selective embolization of right posterior sectoral artery was performed. Hemodynamic status improved dramatically over next 2-3 days but he developed biloma which was drained by percutaneous drainage. General condition improved in the next 2 weeks and drain was removed. Child is doing fine and is completely healthy at 3months of follow-up. Conclusion: Major liver laceration can be managed successfully without surgery by interventional methods in specialized tertiary care centres.