Pediatric emergency medicine trisk 3192 3192

FIGURE 103.6 Abdominal computed tomography of an unrestrained 13-year-old girl in a
rollover motor vehicle collision. A liver fracture is evident with differential perfusion of the
lobes of the liver. Additional injuries included lung contusion.

Blunt liver trauma is the most common fatal abdominal injury ( Figs. 103.6 and
103.7 ). Mechanisms of injury are those that are in common with splenic trauma.
Diffuse abdominal tenderness may be a result of hemoperitoneum, but maximal
tenderness is elicited in the right upper quadrant of the abdomen. Right shoulder
pain is an occasional complaint.
As with trauma to the spleen, nonoperative management of blunt hepatic
injuries has become more common and is now the rule rather than the exception.
Nonoperative management of isolated spleen and liver injuries without blood
transfusion is the standard of care in pediatric trauma care facilities and is
successful in 95% and 90% of cases, respectively.