Pediatric Hepatic and Biliary Tract Injuries

Abstract

This chapter provides a comprehensive overview of pediatric hepatic and biliary tract injuries, covering their etiologies, clinical presentations, diagnostic workup, treatment modalities, and associated complications. Beginning with an introduction to the topic, the chapter delves into the anatomical considerations of the liver and biliary tract in children, elucidating the unique aspects pertinent to this population. Etiologies and mechanisms of injury are explored, followed by a detailed discussion on the clinical manifestations observed in pediatric patients. AAST classifications for liver and biliary tract injuries, along with WSES and Bismuth classifications, are outlined to facilitate a structured understanding of injury severity.

Diagnostic workup strategies, including various imaging investigations such as FAST, DPL, CT, scintigraphy, MRCP, ERCP, and PTC, are meticulously examined to guide clinicians in their assessment. The chapter further elucidates non-operative and operative treatment modalities, including the indications and management strategies under each approach. Lastly, complications associated with pediatric hepatic and biliary tract injuries, including hemobilia, intrahepatic bile duct rupture, bilhemia, intrahepatic hematomas, vascular outflow obstruction, gallstones and cholecystitis, and iatrogenic complications, are discussed to underscore the importance of vigilant monitoring and management in this vulnerable patient population.