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Avoiding splenectomy in the treatment of children with splenic injury
K Lännergren1, P Tordai, T Linné
1Department of Paediatric Surgery, St. Göran's Children's Hospital, Stockholm, Sweden.
Insights
Non-operative management for traumatic spleen rupture is effective in children. This approach led to shorter hospital stays and successful outcomes in most cases, making it a viable alternative to splenectomy.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Surgical Outcomes
Background:
- Traumatic spleen rupture is a common injury in children.
- Historically, splenectomy was the standard treatment.
- Non-operative management (NOM) is increasingly considered.
Purpose of the Study:
- To compare outcomes of splenectomy versus non-operative management for pediatric blunt splenic trauma.
- To evaluate the safety and efficacy of NOM in this population.
Main Methods:
- Retrospective study of 92 pediatric patients with blunt splenic trauma.
- Group A: 46 children treated with splenectomy.
- Group B: 46 children managed non-operatively, with splenic repair as an alternative.
Main Results:
- NOM was successful in 40 of 46 children (Group B).
- Splenic repair was performed in 5 patients; 1 splenectomy in Group B.
- Median hospital stay was shorter for splenectomy (8.0 days) compared to NOM (12.5 days).
- A biphasic course was observed in 23 NOM patients without evidence of delayed rupture.
Conclusions:
- Non-operative management is a safe and effective strategy for pediatric blunt splenic trauma.
- NOM should be considered as a primary treatment option.
- Further investigation into the biphasic course of NOM is warranted.
Abstract:
Ninety-two consecutive patients with traumatic rupture of the spleen were studied. Of the first 46 children (group A), 44 underwent splenectomy. In the subsequent group (group B) non-operative management was successful in 40 of 46 patients, five patients were operated with splenic repair, and one had the spleen removed. All the ruptures were caused by blunt trauma and the severity of the splenic injury was roughly the same in the two groups of patients. A third of the patients in each group had associated injuries, renal injury being the most common intraabdominal lesion. The median hospital stay was 8.0 days (range 5 to 28) in group A and 12.5 days (range 7 to 18) in group B. Among the 40 patients who were treated conservatively, a biphasic course was seen in 23: one or two days after the accident a period of increased pulse rate, fever and increased abdominal tenderness and pain followed, but no evidence for a delayed rupture was found. Our results of conservative treatment of splenic rupture are encouraging and show that non-operative management should be considered in most cases.