2. Transcatheter Arterial Embolization（TAE）for Severe Hepatic Injury in Children

Hitoshi Hirakawa, Shigeru Ueno, Tomoya Hinoki, Tohru Morioka1）, Shuichi Douwaki2）
Yutaka Imai3）, Jun Koizumi3）, Yoshirou Iwata3）, Kazuki Myoujin3）, Sadaki Inokuchi4）

Department of Pediatric Surgery1）, Gastroenterological Surgery1）,
Radiology3） and Emergency and Critical Medicine4）, Tokai University School of Medicine

Abstract
　　Ninety-four pediatric cases of blunt hepatic injury were treated over 26 years. Eighty patients recovered with conservative management. Fourteen patients were treated operatively either by hepatectomy(n=4), non-hepatectomy(n=6) or TAE (n=4). Before 1990, 3 of 4 cases with hepatectomy(85％) and 5 of 6 non-hepatecomy(83％) patients were treated through laparotomy. Since 2000 TAE has become the main management technique for severe hepatic injury with arterial bleeding. Three of 4 TAE-treated patients were hemodynamically instable despite fluid restration before TAE but the bleeding was stopped completely by TAE. Two TAE-treated patients had delayed complications caused by biliary tract injury. One was diagnosed with biliary peritonitis, which recovered by drainage operation. Another patient had right hepatic duct injury causing a huge biloma which was treated by endoscopic retrograde stenting. In conclusion, TAE is considered as a most effective procedure and should be initially attempted instead of hepatectomy for severe hepatic injury even in hemodynamically unstable condition although this nonoperative approach might carry the risk of treatment delay for biliary tract injury.

Keywords：Hepatic injury, TAE, Children