Nonoperative Management of Pediatric Liver Injury: Current Evidence, Clinical Indications, and Outcomes.

Background and Objectives: Pediatric liver injury is a frequent solid organ injury after blunt abdominal trauma, and its management has progressively shifted toward nonoperative care in hemodynamically stable children. This narrative review aims to synthesize current evidence regarding diagnosis, eligibility for nonoperative management, inpatient monitoring, outcomes, complications, escalation criteria, and post-discharge care in pediatric liver trauma. Materials and Methods: A structured literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science, with supplementary screening through Google Scholar and reference lists. Publications from January 2000 to December 2025 were considered. The literature was analyzed descriptively and thematically, without formal risk-of-bias assessment, evidence grading, or quantitative meta-analysis. Results: The available evidence supports nonoperative management for most children with blunt liver injury who are hemodynamically stable or show a sustained response to initial resuscitation. Eligibility depends primarily on physiological status, clinical evolution, associated injuries, and institutional capability rather than imaging grade alone. Nonoperative management requires structured clinical, hemodynamic, and laboratory reassessment, with follow-up imaging reserved for selected cases based on clinical evolution or suspected complications. Delayed hemorrhage, bile leak, biloma, pseudoaneurysm, hemobilia, infection, and failure of nonoperative management remain clinically relevant and may require repeat imaging, interventional radiology, or surgery. Conclusions: Nonoperative management should be understood as an active organ-preserving strategy based on careful selection, serial reassessment, and immediate access to escalation when needed. Further pediatric liver-specific studies are required to standardize monitoring, repeat imaging, intervention thresholds, activity restriction, and post-discharge follow-up.