Operation After Radiologic Embolization for Blunt Liver Trauma

Abstract

Motor vehicle accidents and other blunt high-impact traumas occur with relative frequency in children and adolescents, potentially causing severe injury or death (Martin et al., 2017). A common consequence of blunt trauma is laceration to the solid organs such as liver, kidneys, or spleen. These injuries are typically managed nonoperatively, occasionally utilizing interventional radiology (IR) embolization (Arbra et al., 2017). This case report discusses a child with Grade V+ liver laceration, who underwent IR embolization and ultimately required laparoscopic evacuation of abdominal hemorrhage with peritoneal drain placement. As a complication of IR embolization, the patient developed an occlusive thrombus in his right common femoral artery. A systematic review of nonoperative management in pediatric trauma by the American Pediatric Surgical Association concluded that there is no need to put patients through the risks of an IR embolization procedure if the patient remains stable (Gates et al., 2019). Although the guidelines are useful, clinical judgment remains the best determinant for invasive intervention. From a trauma nursing perspective, these cases require serial abdominal examinations combined with excellent communication between nurses and physicians to highlight changes in physical examination findings. In addition, research on IR procedures in the context of hepatic injury needs further study.