Journal article
Delayed hemorrhage after nonoperative management of blunt hepatic trauma in children: A rare but significant event
Journal of pediatric surgery, Vol.34(1), pp.60-64
1999
DOI: 10.1016/S0022-3468(99)90229-4
PMID: 10022144
Abstract
Purpose:
Nonoperative management of blunt hepatic injury (BHI) has become widely accepted in hemodynamically stable children without ongoing transfusion requirements. However, late hemorrhage, especially after discharge from the hospital can be devastating. The authors report the occurrence of serious late hemorrhage and the sentinel signs and symptoms in children at risk for this complication.
Methods:
Nonoperative management of hemodynamically stable children included computed tomography (CT) evaluation on admission and hospitalization with bed rest for 7 days, regardless of injury grade. Activity was restricted for 3 months after discharge. Hepatic injuries were classified according to grade, amount of hemoperitoneum, and periportal hypoattenuation.
Results:
Over 5 years, nonoperative management was successful in 74 of 75 children. One child returned to the hospital 3 days after discharge with recurrent hemorrhage necessitating surgical control. Review of the CT findings demonstrated that he was the only child with severe liver injury in all four classifications. A second child, initially treated at an outside hospital, presented 10 days after injury with ongoing bleeding and died despite surgical intervention. Only the two children with delayed bleeding had persistent right abdominal and shoulder discomfort in the week after BHI.
Conclusions:
Our findings support nonoperative management of BHI. However, late hemorrhage heralded by persistence of right abdominal and shoulder pain may occur in children with severe hepatic trauma and high injury severity scores in multiple classifications.
Details
- Title: Subtitle
- Delayed hemorrhage after nonoperative management of blunt hepatic trauma in children: A rare but significant event
- Creators
- Joel Shilyansky - Hospital for Sick ChildrenOscar Navarro - Hospital for Sick ChildrenRiccardo A Superina - Hospital for Sick ChildrenPaul S Babyn - Hospital for Sick ChildrenRobert M Filler - Hospital for Sick ChildrenRichard H Pearl - Hospital for Sick Children
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric surgery, Vol.34(1), pp.60-64
- Publisher
- Elsevier Inc
- DOI
- 10.1016/S0022-3468(99)90229-4
- PMID
- 10022144
- ISSN
- 0022-3468
- eISSN
- 1531-5037
- Language
- English
- Date published
- 1999
- Academic Unit
- Stead Family Department of Pediatrics; Surgery
- Record Identifier
- 9984322944902771
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