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[The present status of treatment of splenic injuries in children]
1Zavod za djecju kirurgiju, Klinika za kirugiju, Klinicki bolnicki centar, Rebro, Medicinski fakultet Sveuclista u Zagrebu.
Insights
The spleen plays a crucial role in immune function, making spleen preservation vital. Conservative management is preferred for minor spleen injuries, while surgical intervention is reserved for severe ruptures and trauma.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Immunology
Context:
- The spleen's immunological significance is increasingly recognized.
- Postsplenectomy sepsis poses a serious risk.
- Understanding spleen function informs treatment strategies for splenic injuries.
Purpose:
- To evaluate surgical management of damaged and ruptured spleens in children.
- To emphasize spleen preservation in treating splenic trauma.
- To review treatment outcomes for pediatric splenic injuries.
Summary:
- Ninety children with suspected spleen injuries were analyzed.
- 38 patients were managed non-operatively due to stable hemodynamics.
- 47 underwent diagnostic imaging; 32 showed positive findings.
- 19 patients required surgical intervention, with most undergoing spleen preservation rather than splenectomy.
Impact:
- Highlights the importance of spleen preservation in pediatric trauma.
- Supports conservative management for hemodynamically stable patients with splenic injuries.
- Informs surgical decision-making for ruptured spleens, balancing risks and benefits.
Abstract:
Small but very dangerous risk of postsplenectomic sepses gave rise to the examination of surgical attitudes of medical treatment of damaged and ruptured spleen. Some new ideas of immunology revealed the importance of the spleen in the protection of the host and serious defect of immunologic system if the spleen is removed. According to those ideas, ruptured spleen is to be retained by all means. Some minor lesions and hemorrhages that are easily controlled by conservative measures, are not to be operated. In case of serious ruptures and massive hemorrhages necessitating more than 20 ml/kg of fresh blood to replace lost volume, penetrated abdominal injuries and with polytraumatic patients, laparotomy, surgical hemostasis and preservation of the spleen are indicated if possible. In the period of the last eight years, 90 children were treated because of the possibility they had injured spleen. Thirty-eight patients (42%) were under observation. Hemodynamic indicators were normal, so we did not make any aggressive diagnostic examinations. Other 47 patients had splenic scintigraphy, computed tomography (CT) of the abdomen or ultrasound examination. The findings were positive with 32 (69%) patients. Of those patients, 14 (44%) were immediately operated since serious rupture of the spleen was diagnosed and clinical signs suggested the presence of severe abdominal bleeding. To this number of operated patients, four polytraumatic patients and one suffering from penetrated injury are to be added. They were indicated the exploration of the abdomen without previous diagnostics. There were 19 surgical treatments of ruptured spleen; three of them included splenectomy while the other patients underwent splenic preservation.(ABSTRACT TRUNCATED AT 250 WORDS)