Right hepatic vein injury after blunt abdominal trauma in a 12-year-old boy : case report

Background: Blunt abdominal trauma in children is one of the most frequent causes of hospitalization. We present a rare case of traumatic liver injury. Case report: A 12-year-old boy was admitted to the Surgery Department after a bicycle fall and handlebar impact injury to the right infracostal area. At admission he was stable, with no abnormalities, except for a subcutaneous hematoma found in the injured area. Abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography (CT) revealed irregular branching laceration of the right superior hepatic segments with extension into the hepatic veins. No active extravasation of contrast material was seen. On the next day, because of the deterioration of the patient’s condition, CT examination was repeated and revealed focal extravasation of contrast material in the portal hilum, posterior to the gallbladder. An injury of the right hepatic vein was found on laparotomy. Conclusions: Hepatic vein injury is a rare but very serious complication after blunt liver trauma and it is an indication for surgical treatment. Diagnostic imaging is essential for therapeutic decisions, but its value is sometimes limited. The precise analysis of injury mechanism and localization may be very helpful. CT is currently the modality of choice for the evaluation of blunt liver trauma. If an active bleeding is suspected the delayed scans seem to be recommended