• Syed Waqas Ali, Areej Salim, Uzair Aslam, Saad Khalid, Muhammad Sajjad Ashraf, and KhanMuhammad Arif MateenMAMDepartment of Pediatric Surgery, Dow University of Health Sciences, Karachi, Pakistan. arif.mateen@duhs.edu.pk.Pediatric Surgery, Aga Khan University of Health Sciences, Karachi, Pakistan. arif.mateen@duhs.edu.pk..
• Department of Pediatric Surgery, Dow University of Health Sciences, Karachi, Pakistan.
• Eur J Trauma Emerg Surg. 2024 Jun 1; 50 (3): 829836829-836.

ObjectiveTo present our experience of multidisciplinary management of high-grade pediatric liver injuries.IntroductionPediatric high-grade liver injuries pose significant challenge to management due to associated morbidity and mortality. Emergency surgical intervention to control hemorrhage and biliary leak in these patients is usually suboptimal. Conservative management in selected high-grade liver injuries is now becoming standard of care. Management of hemobilia due to pseudoaneurysm formation and traumatic bile leaks requires multidisciplinary management.MethodsA retrospective review was undertaken for patients presenting with blunt liver injuries at two tertiary care centers in Karachi, Pakistan, from March 2021 to December 2022. Twenty-eight patients were identified, and four patients fulfilled the criteria for grade 4 and above blunt liver injury during this period.ResultsOne case with grade 4 liver injury developed hemobilia on 7th day of injury. He required two settings of angioembolization but had recurrent leak from pseudoaneurysm. He ultimately needed right hepatic artery ligation. Second patient presented with massive biliary peritonitis 2 days following injury. He was managed initially with tube laparostomy followed by ERCP and stent placement. The third patient developed large hemoperitoneum managed conservatively. One case with grade 5 injury expired during emergency surgery.ConclusionConservative management of advanced liver injuries can result in significant morbidity and mortality due to high risk of complications. Trauma surgeons need to have multidisciplinary team for management of these patients to gain optimal outcome.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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