Case report: Management of pediatric blunt abdominal trauma following an ATV accident leading to liver hilum injury

Blunt abdominal trauma from the ever-popular all-terrain vehicle is becoming an increasing concern in pediatrics. Non-operative management has become the standard of care for isolated blunt hepatic injuries. However, operative intervention is still warranted in hemodynamically unstable patients and for any serious delayed complications such as liver devascularization and liver failure. This case report presents a pediatric patient with an isolated Grade V blunt hepatic trauma following a quad rollover. After the initial damage control laparotomies, due to ongoing bilious drainage, clinical deterioration and extensive free fluid on imaging, the patient went for a repeat exploratory laparotomy. This showed significant injuries to the vascular and biliary systems, involving both hepatic lobes. The patient was followed closely with imaging, as the fear of liver devascularization was high, with a follow-up computed tomography (CT) scan showing subtle signs of atrophy. The patient was admitted three months later for an uncomplicated delayed hepaticojejunostomy. Delay in diagnosis of biliary system damage following trauma is not uncommon but concomitant vascular injuries to both lobes of the liver is rare. Possible liver ischemia should be followed at a major trauma center, monitoring for any secondary complications and to assess the need for surgical resection or transplantation.