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Splenectomy after paediatric trauma: could more spleens be saved?
1Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, UK.
Aims:
Guidelines for the emergency management of paediatric splenic trauma became widely available in 1993. A regional survey was undertaken to assess the application of Advanced Paediatric Life Support guidelines to children who had undergone splenectomy after trauma.
Patients And Methods:
All children who had undergone splenectomy for a ruptured spleen at 8 district hospitals and 2 teaching hospitals in our region between January 1994 and January 1999 were identified from histopathology departmental records. With appropriate permission their case notes were reviewed.
Results:
Eleven children (9 males) were identified, all from district hospitals, with a median age at presentation of 11.8 years (range, 6.6-16.8 years). All presented within 6 h of blunt abdominal trauma. Median systolic blood pressure, pulse rate, haemoglobin concentration and injury severity score (ISS) on admission were 115 mmHg (range, 80-140 mmHg), 108 bpm (range, 84-150 bpm), 12.1 g/dl (range, 10.7-12.8 g/dl) and 17 (range, 17-29), respectively. Three children had additional relatively minor injuries. On admission, 3 children received an intravenous fluid bolus of 20 ml/kg and the remainder received only maintenance fluid requirements or less. Five children were investigated by ultrasound imaging, one by double contrast CT scan, and three by laparoscopy. Two children had no imaging studies prior to laparotomy. Laparotomy was performed by a consultant surgeon in 7 cases and by a specialist registrar in 4 cases. Ten children underwent total splenectomy and one child had a partial splenectomy. Median hospital stay was 7 days (range, 5-10 days). The child with an ISS of 29 developed a persistent pancreatic fistula and subsequently required a distal pancreatectomy. All children received Pneumovax and penicillin prophylaxis.
Conclusions:
All children made a full recovery without surgical morbidity. However, none of these cases fulfilled the recommended criteria for laparotomy in children with blunt abdominal trauma and splenectomy may have been avoidable.