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

Objective: Blunt liver trauma in pediatric patients presents a significant clinical challenge, especially in high-grade injuries complicated by multiple life-threatening conditions. While non-operative 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.