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Multimodality management in severe pediatric spleen trauma
M Iuchtman1, R Alfici, E Sternberg
1Department of Surgery A, Hillel Yaffe Medical Center, Hadera and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. http:/hy.health.gov.il
Insights
Pediatric spleen trauma management can preserve spleen tissue using mesh wrapping and autotransfusion. This multimodality approach ensures survival and spleen function in children with severe spleen rupture.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Spleen Preservation
Background:
- Trauma is a leading cause of death in children.
- Abdominal injuries frequently involve the spleen.
- Spleen tissue conservation has been a focus in recent decades.
Purpose of the Study:
- To analyze a multimodality management policy for pediatric spleen injuries.
- Evaluate the use of autotransfusion and mesh wrapping in spleen conservation.
Main Methods:
- Retrospective analysis of 14 years of data (1985-1998).
- Inclusion of 122 children treated for severe spleen rupture.
- Application of techniques including absorbable mesh wrapping, partial splenectomy, and autotransfusion.
Main Results:
- Mesh wrapping was used in 16 children to achieve hemostasis and preserve spleen tissue.
- All children survived with a functional spleen.
- No cases of rebleeding were reported; one instance of postoperative fever was managed successfully.
Conclusions:
- Mesh wrapping, partial splenectomy, and autotransfusion are effective in preserving severely injured spleens.
- Autotransfusion is a simple technique valuable in resource-limited settings or mass casualty incidents.
- This multimodality approach leads to successful outcomes in pediatric spleen trauma.
Background:
Trauma is the leading cause of death in children. In abdominal lesions the spleen is the most commonly involved organ. During the last two decades much effort has focused on spleen tissue conservation.
Objectives:
To analyze the rationale of a multimodality management policy that includes autotransfusion and mesh wrapping.
Methods:
Data gathered over 14 years illustrate the introduction of new techniques and their impact on cases of severe spleen rupture.
Results:
A total of 122 children were treated during the 14 year period, 1985-98. In 16 children an absorbable mesh wrapping, alone or in combination with other techniques, was used to obtain hemostatis and save spleen tissue.
Conclusions:
Mesh wrapping, partial splenectomy and autotransfusion can be used, alone or in combination, to preserve severely injured spleens. According to our records, all children survived with a functional spleen. There were no cases of rebleeding. In only one case of prolonged postoperative fever could the cause be traced to an infected spleen hematoma that was drained transcutaneously. Autotransfusion is performed simply and without the use of a "cell saver." Its use can be crucial in small or field hospitals or in a situation of mass casualty.
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