Liver Injury

Liver injury in children can result from either blunt or penetrating mechanisms and can result in hemodynamically significant bleeding. The initial management of pediatric patients presenting with abdominal trauma follows ATLS principles to facilitate timely and lifesaving interventions. The index for suspicion for abdominal trauma is based on mechanism and physical exam findings. Elevation in liver-associated enzymes can be suggestive of liver injury in equivocal cases. CT evaluation of the abdomen defines the extent of liver injury. Hemodynamic status dictates intervention including transfusion, angioembolization, and operative intervention. The majority of blunt liver injuries can be managed non-operatively, and recently published society guidelines should serve as a reference for this strategy. Follow-up imaging is not recommended in asymptomatic patients and should be used to diagnose complications in patients demonstrating symptoms. Complications following liver injury managed either operatively or non-operatively are rare but may need additional interventions for management.