Successful management of hepatic vein injury from blunt trauma in children

• Published in: The American journal of surgery Vol. 140; no. 6; pp. 858 - 864
• Main Authors: Coln, Dale, Crighton, John, Schorn, Larry
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.1980
• Subjects: Child; Child, Preschool; Female; Hemorrhage - surgery; Hepatic Veins - injuries; Hepatic Veins - surgery; Humans; Infant; Liver - injuries; Liver - surgery; Male; Wounds, Nonpenetrating - surgery
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/0002-9610(80)90132-4

In children, the majority of deaths from blunt trauma to the liver are caused by large stellate fractures of the posterolateral aspect of the right lobe of the liver with extension into the hepatic veins. Four children with such injuries were successfully treated. Hypotension and abdominal tenderness are not early manifestations of this highly lethal injury in children. When an appropriate mechanism for liver injury exists, paracentesis or peritoneal lavage, followed by prompt laparotomy for hemoperitoneum, gives the best chance for early and successful treatment. Large cannulas in arm veins and cross matching for twice the patient's blood volume are used when there is a possibility of a liver injury. The important aspects of operative management are identification of the injury when the abdomen is first opened and prompt control of bleeding. The possibility of hepatic vein injury exists if the surgeon finds the coronary ligament disrupted by a large liver laceration on the posterolateral liver surface. Compressing the liver against the diaphragm will usually control the bleeding while blood replacement is accomplished. The hepatic vein entrance into the inferior vena cava is then exposed using a median sternotomy, if necessary. Partial occlusion of the inferior vena cava can usually be safely done with this direct approach if the blood volume has been restored. Frequently, valuable time and blood are lost if attempts are made to insert internal shunts.