Damage control surgery for grade IV blunt hepatic injury with multiple organ damage in a child: a case report

Abstract

Background Intra-abdominal hemorrhage caused by blunt hepatic injury is a major cause of morbidity and mortality in patients with abdominal trauma. Some of these patients require laparotomy, and rapid decision-making and life-saving surgery are essential. Damage control (DC) surgery is useful for treating children in critical situations. We performed this technique to treat an 8-year-old boy with grade IV blunt hepatic injury and multiple organ damage. This is the first report of the use of the ABTHERA Open Abdomen Negative Pressure Therapy System (KCI, now part of 3 M Company, San Antonio, TX, USA) for DC surgery to rescue a patient without neurological sequelae. Case presentation An 8-year-old boy was brought to the emergency department of our hospital after being run over by a motor vehicle. He had grade IV blunt hepatic injury, thyroid injury, and bilateral hemopneumothorax. Although he was hemodynamically stable, the patient’s altered level of consciousness, the presence of a sign of peritoneal irritation, and suspicion of intestinal injury led us to perform exploratory laparotomy. As part of a DC strategy, we performed gauze packing to control hemorrhage from the liver and covered the abdomen with an ABTHERA Open Abdomen Negative Pressure Therapy System to improve the patient’s general condition. Eighteen days after admission, the patient was diagnosed with a biliary fistula, which improved with percutaneous and external drainage. He had no neurological sequelae and was discharged 102 days after injury. Conclusion The DC strategy was effective in children with severe blunt hepatic injury. We opted to perform DC surgery because children have less hemodynamic reserve than adults, and we believe that using this strategy before the appearance of trauma triad of death could save lives and improve outcomes. During conservative management, it is important to adopt a multistage, flexible approach to achieve a good outcome.

Successful non-operative management of multiple intra-abdominal solid organ injury after blunt abdominal trauma: a case report

“…Nevertheless, NOM has steadily replaced surgery as the line of management throughout the last two decades [ 1 ]. This shift in NOM has been aided by advancements in critical care monitoring and CT scan, as well as increased use of interventional radiology procedures, such as angioembolization, percutaneous drainage, and nephrostomies insertion [ 6 ]. However, despite developing relatively less invasive procedures, higher grades of solid organ injuries still need to be treated surgically if the hemodynamic stability is compromised [ 7 ].…”

“…and Soma et al . [ 4 , 6 ]. The organ injury scaling (OIS) system was developed by American association for the surgery and based on the magnitude of anatomic disruption and is graded as 1 (minimal), 2 (mild), 3 (moderate), 4 (severe), 5 (massive), and 6 (lethal) [ 8 ].…”

Dispositivo de presión negativa empleado en pacientes pediátricos con abdomen hostil: serie de casos

“…La gestión del abdomen abierto conlleva un mayor riesgo de infección en pacientes pediátricos que en adultos debido a la rápida pérdida de calor y al escaso volumen sanguíneo. El dispositivo de TPN ABTHERA se adapta fácilmente a las necesidades relacionadas con las heridas abdominales en la población pediátrica (3) .…”

“…La terapia de presión negativa (TPN) ha sido descrita ampliamente en adultos, pero no así en pacientes pediátricos (3) .…”

Negative pressure device used in pediatric patients with hostile abdomen. Case series

“…Negative pressure therapy (NPT) use has been widely described in adults; the case is not the same for pediatric patients (3) .…”