Abstract
The liver is the abdominal organ most susceptible to injury from blunt trauma. Grade V liver injuries, as classified by the American Association for the Surgery of Trauma Organ Injury Scale, are associated with high mortality rates and typically require emergency surgical intervention. However, such cases are rarely reported in the pediatric population. Herein, we report the successful management of a pediatric case of Grade V liver trauma. We performed damage-control surgery in a 7-year-old boy with grade V liver trauma in our hybrid operating room, focusing primarily on controlling intra-abdominal hemorrhage originating from the liver. Initial hemostatic measures, including perihepatic packing and transcatheter arterial embolization, failed to achieve complete hemostasis. However, successful hemostasis was obtained through the combined use of Floseal®, a topical hemostatic agent, and hepatorrhaphy. A second-look operation revealed partial hepatic necrosis and bile leakage. Instead of hepatic resection, a less invasive drainage of the injured area was performed. As postoperative bile leakage persisted, endoscopic nasobiliary drainage was subsequently implemented, effectively resolving the issue. The patient recovered without further complications and was discharged on postoperative day 59. This case highlights the clinical efficacy of the novel hemostatic agent Floseal® in the management of severe pediatric Grade V liver injury, as well as the utility of conservative approaches in treating postoperative biliary leakage.
