Nonoperative management and delayed hemorrhage after pediatric liver injury: new issues to consider

The authors report the case of a grade 4 liver laceration caused by blunt abdominal trauma. The liver injury was managed nonoperatively, both initially and after an episode of delayed hemorrhage. The patient suffered 2 additional as yet unreported complications of pediatric liver injury: a right pleural effusion causing respiratory embarrassment followed by duodenal obstruction; the latter was caused by hypertrophy of the left lobe of the liver. Although numerous reports suggest that delayed hemorrhage after pediatric liver injury should be managed operatively, the mortality of such intervention remains high, reaffirming the dictum that one must treat the patient and not the injury.