Journal of pediatric surgery · 2026
Biliary Complications After High-Grade Blunt Liver Trauma in Children: Impact of Early Recognition on Management Burden.
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Sollami Giulia, Rabiolo Lidia, Cristofalo Giuseppe, Coppolino Davide, Maruzzelli Luigi, Milazzo Mariapina, Mamone Giuseppe, Tarantino Ilaria, Rizzitello Nicolò, Miraglia Roberto, de Ville de Goyet Jean
Аннотация
BACKGROUND/PURPOSE: Biliary complications (BIC) are rare after high-grade blunt liver trauma in children, but a recognized source of morbidity. The main clinical issue is whether they are recognized in time to limit treatment burden. This study evaluated the incidence, presentation, and management of BIC after high-grade blunt liver trauma in a pediatric referral cohort.
METHODS: All consecutive children younger than 18 years referred to a quaternary pediatric hepatobiliary center between January 2006 and December 2025 for severe blunt liver injury were retrospectively reviewed. Demographic data, injury grade, timing of diagnosis, treatment, and clinical outcomes were analyzed. Length of hospital stay was used as a surrogate marker of management burden.
RESULTS: Eighteen BIC events were identified in 18 children, including 15 biliary fistulas and 3 bilomas. BIC occurred more often with increasing injury severity, affecting 20% of grade III, 50% of grade IV, and 67% of grade V injuries (P= 0.046). Median hospital stay was longer in children with BIC than in those without BIC (21 days [IQR, 16.5-33.5] vs 9.5 days [IQR, 7-13]; P = .007). In children who underwent planned second-look laparotomy after peri-hepatic packing, bile leak was recognized early, with trans-cystic drainage allowing single step cure; delayed diagnosis on the other hand was significantly associated with more complex and staged management, including percutaneous drainage, endoscopic or delayed interventions (P< 0.01).
CONCLUSION: Timely recognition was associated with simpler management and shorter hospitalization, suggesting that structured surveillance of selected high-risk injuries should be incorporated into contemporary nonoperative management pathways.
METHODS: All consecutive children younger than 18 years referred to a quaternary pediatric hepatobiliary center between January 2006 and December 2025 for severe blunt liver injury were retrospectively reviewed. Demographic data, injury grade, timing of diagnosis, treatment, and clinical outcomes were analyzed. Length of hospital stay was used as a surrogate marker of management burden.
RESULTS: Eighteen BIC events were identified in 18 children, including 15 biliary fistulas and 3 bilomas. BIC occurred more often with increasing injury severity, affecting 20% of grade III, 50% of grade IV, and 67% of grade V injuries (P= 0.046). Median hospital stay was longer in children with BIC than in those without BIC (21 days [IQR, 16.5-33.5] vs 9.5 days [IQR, 7-13]; P = .007). In children who underwent planned second-look laparotomy after peri-hepatic packing, bile leak was recognized early, with trans-cystic drainage allowing single step cure; delayed diagnosis on the other hand was significantly associated with more complex and staged management, including percutaneous drainage, endoscopic or delayed interventions (P< 0.01).
CONCLUSION: Timely recognition was associated with simpler management and shorter hospitalization, suggesting that structured surveillance of selected high-risk injuries should be incorporated into contemporary nonoperative management pathways.