Management and treatment of liver injury in children

BACKGROUND: We aimed to assess the causes of trauma that result in liver injury and additional solid organ injuries, management types and results of management in children referred to our clinic for liver injuries.
METHODS: The records of 52 patients who were managed for liver injuries due to blunt abdominal trauma between January 2005-2010 were reviewed retrospectively.
RESULTS: The patients were 1-17 (8.3±5.4) years old; 32 (62%) were male and 20 (38%) were female. Causes of injuries included pedestrian traffic accidents (19, 37%), falls from height (15, 29%), passenger traffic accidents (8, 15%), bicycle accidents (8, 15%), and objects falling on the body (2, 4%). Isolated liver injury was present in 32 patients (62%), while 20 patients (38%) had other organ injuries. Liver injuries were grade I in 6 patients (12%), grade II in 14 (28%), grade III in 22 (43%), grade IV in 9 (17%), and grade V in 1 (2%). Forty-five patients (87%) were managed conservatively in this series of liver injury, whereas seven patients (13%) who had unstable vital signs underwent surgery. The mortality rate, duration of stay in intensive care and hospital, and number of blood transfusions were higher in surgically managed patients, while hemoglobin level and blood pressure were significantly lower in surgically managed patients.
CONCLUSION: As a result, conservative management should be preferred in patients with liver injuries who are hemodynamically stable. Conservative management has some advantages, including shorter duration of stay in hospital, less need for blood transfusion and lower morbidity and mortality rates.

Çocuklarda karaciðer yaralanmasýnda yönetim ve tedavi

AMAÇ: Karaciðer travmasý nedeniyle son 7 yýlda kliniðimize baþvuran çocuklarda travma tiplerini, eþlik eden solid organ yaralanmalarýný, tedavilerini ve tedavi sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Kliniðimizde Ocak 2005-Ocak 2012 arasýnda künt karýn travmalarýna baðlý karaciðer yaralanmasý nedeniyle tedavi edilen 52 hasta retrospektif olarak deðerlendirildi.
BULGULAR: Hastalarýn yaþlarý 1-17 (ortalama 8.3±5.4) yaþ arasýnda olup 32’si (%61.6) erkek, 20’si (%38.4) kýzdý. Hastalar en sýk araç dýþý trafik kazasý (19, %37), yüksekten düþme (15, %29), araç içi trafik kazasý (8, %15), bisiklet kazalarý (8, %15) ve üzerine cisim düþme (2, %4) nedeniyle baþvurdu. Hastalarýn 32’sinde (%61.5) izole karaciðer, 20’sinde (%38.5) eþlik eden diðer organ yaralanmalarý vardý. Hastalarýn 6’sýnda kafa (%11.5), 4’ünde (%7.6) toraks, 4’ünde (% 7.6) ekstremite, 3’ünde (%5.7) çoklu yaralanma vardý. Karýniçi organlardan 8’inde böbrek (%15), 8’inde (%15) dalak, 2’sinde (%4) GÝS, 2’sinde (%4) pankreas yaralanmasý vardý. Altý hasta (%11.5) Evre I, 14 hasta (%27) Evre II, 22 hasta (%42.5) Evre III, 9 hasta (%17) Evre IV, 1 hasta (%2) Evre V idi. Evre I ve II olan tüm hastalar konservatif tedavi yapýlýrken, cerrahi tedavi yapýlan 1 hasta (%4.5) evre III, 5 hasta (%50) evre IV, 1 hasta (%100) ise Evre V idi. Bu çalýþmada 52 hastanýn 45’i (% 86.5) konservatif takip edilirken, vital bulgularý stabil olmayan 6 hasta ameliyat edildi. Bir hasta ameliyat sýrasýnda hayatýný kaybetti (%1.9).
TARTIÞMA: Sonuç olarak, karaciðer travmalarýnda hemodinamik olarak stabil seyreden hastalarda konservatif tedavi tercih edilmelidir. Çocuklarda karaciðer travmalarýnýn çoðu konservatif tedavi edilebilmektedir. Konservatif tedavi daha kýsa hastanede kalýþ süresi, daha az transfüzyon ihtiyacý, morbiditenin ve mortalitenin daha düþük olmasý gibi avantajlara sahiptir.