Delayed Presentation of Severe Blunt Liver Trauma Following a 12-Foot Fall: A Case Report of a Grade 4 Hepatic Injury With a Concurrent Grade 1 Renal Injury

TL;DR

A 15-year-old girl suffered delayed severe liver and minor kidney injuries from a fall, highlighting unique challenges in diagnosing and managing adolescent liver trauma.

Contribution

This case report highlights the delayed presentation and management complexities of adolescent blunt liver trauma.

Findings

Delayed symptoms in adolescents with liver trauma can complicate diagnosis and management.

Emergency laparotomy and hepatic packing were crucial for successful treatment in this case.

Adolescents face unique challenges due to larger space for the liver and immature organ structure.

Abstract

The delayed presentation of a 15-year-old female with a complex Grade 4 liver injury and a concurrent Grade 1 renal injury sustained from a fall exemplifies the heightened vulnerability of adolescents to blunt hepatic trauma. Unlike typical presentations where symptoms like abdominal pain and internal bleeding appear immediately, this case emphasises the potential for delayed manifestation, posing unique challenges for diagnosis and management. This case, managed at a leading trauma centre, underscores the distinct challenges compared to adult cases due to adolescents' larger space available for the organ and immature livers. While presenting more management complexity than typical splenic injuries, prompt intervention with emergency laparotomy and hepatic packing proved crucial for the patient's successful outcome. This case emphasises the critical role of early identification, vigilant monitoring, and strict activity restrictions post-operatively for optimal adolescent liver trauma management and serves as a reminder of the spectrum of potential injuries, including bile duct and vascular damage alongside contusions and haematomas.

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