HAZARDS OF NONOPERATIVE THERAPY OF HEPATIC-INJURY IN CHILDREN

Several reports suggest that pediatric patients with stable liver injuries can be managed nonoperatively with few complications. From March 1978 to July 1983, 7 children with hepatic injury were managed without surgery at CHNMC [Children''s Hospital National Medical Center, USA]. Four children required > 50% total blood volume replacement, while the mean PRBC [packed red blood cell] transfusion rate was 28 ml/kg. Eight major complications developed in 5 patients. Hospitalization averaged 23 days, without a mortality. This morbidity is greater than that described in earlier reports. In view of the limited cumulative clinical experience, routine nonoperative management of liver trauma in children is cautioned against until data with this new technique become available for analysis.