Journal of Emergency Practice and Trauma

Overcoming the Odds: A Case Report of Pediatric Grade V Liver Injury with Severe Complications

Document Type : Case Report

Authors

Despoina Panayiotou 1
Adelais Tzortzopoulou 2
Moschos Ververidis 1
Ioannis Skondras 1
Eleni Koutrouvel 2
Constantinos Tsilikas 3
Orthodoxos Achilleos 1

1 Pediatric Surgery Department, General Children’s Hospital of Athens “P.&A. Kyriakou”, Athens, Greece

2 Radiology Department, General Children’s Hospital of Athens “P.&A. Kyriakou”, Athens, Greece

3 Radiology Department, “Agia Sophia” Children’s Hospital, Athens, Greece

https://doi.org/Doi:10.34172/jept.2025.19
Abstract
Objective: Blunt liver trauma in pediatric patients presents a significant clinical challenge,
especially in high-grade injuries complicated by multiple life-threatening conditions. While nonoperative management (NOM) is the standard of care for hemodynamically stable patients, severe
complications require an individualized, multidisciplinary approach.
Case Presentation: We present a 15-year-old boy with a grade V blunt liver injury following a
car accident. Initially stabilized with non-operative management, he later developed three rare
complications: abdominal compartment syndrome, acute kidney injury, and bile leakage. The
first two complications were treated with emergency decompressive laparotomy and continuous
renal replacement therapy. At the same time, bile leakage from a disrupted right posterior hepatic
duct was managed with percutaneous drainage and adjunctive glucagon therapy. With vigilant
monitoring and tailored interventions, he showed marked recovery within 2 months, and follow-up
imaging confirmed substantial improvement.
Conclusion: This case highlights the delicate balance of managing severe pediatric trauma, blending
established protocols with innovative approaches. The occurrence of three rare complications
in a single patient underscores the exceptional nature of this case. Successful management of
abdominal compartment syndrome, acute kidney injury, and bile leakage demonstrates the
importance of early diagnosis, multidisciplinary teamwork, and adaptability in complex trauma
care. It exemplifies how integrating evidence-based practices with novel strategies can transform
life-threatening conditions into successful recoveries

Keywords

Liver injury
Children
Abdominal Compartment Syndrome
Acute kidney injury
Subjects
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Journal of Emergency Practice and Trauma
Volume 10, Issue 2
July 2024
Pages 165-170

  • Receive Date 13 July 2025
  • Revise Date 20 September 2025
  • Accept Date 05 October 2025

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