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[Splenic injuries: therapeutic orientation. Apropos of 46 cases]
Insights
Conservative management for pediatric splenic trauma is effective. Ultrasound and scintigraphy aid diagnosis, enabling non-operative treatment for stable patients, with good outcomes and shorter hospital stays.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Diagnostic Imaging
Background:
- Splenic trauma is a significant concern in pediatric patients.
- Traditional management often involved surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of non-operative management for pediatric splenic trauma.
- To assess the role of diagnostic imaging in guiding treatment decisions.
Main Methods:
- Retrospective review of 46 pediatric splenic trauma cases treated between 1979 and 1983.
- Utilized ultrasound for initial lesion detection and peritoneal fluid assessment.
- Employed splenic scintigraphy for diagnosis confirmation and monitoring resolution.
Main Results:
- 35 out of 46 patients (76%) were managed non-operatively with successful outcomes.
- Ultrasound effectively identified splenic lesions and hemoperitoneum.
- Splenic scintigraphy proved valuable for diagnosis and follow-up.
- Conservative management group had an average hospital stay of 11 days with no related mortality or morbidity.
- Transfusion rates were lower in the non-operative group compared to operated patients.
Conclusions:
- Non-operative management is a safe and effective strategy for pediatric splenic trauma in hemodynamically stable children.
- Ultrasound and scintigraphy are crucial for accurate diagnosis and treatment selection.
- Routine abdominal TAP (thoracic-abdominal puncture) may not be necessary for all abdominal trauma cases.
Abstract:
Between 1979 and june 1983, 46 splenic trauma, with or without associated lesions, have been treated at Sainte'-Justine's Hospital. 8 children had a splenectomy, 3 had a laparotomy for other lesions without a splenectomy was done. 35 had a non operative management of splenic trauma. The ultrasound shows the splenic lesions and the blood in the peritoneal cavity. So, the "Routine Abdominal TAP" does not seem necessary in every abdominal trauma. The splenic scintigraphy is, for, now, the best exam to confirm the diagnosis and to assess the resolution of splenic lesion in 1 to 4 months. Transfusions were done in 8 of 11 operated patients and in 11 of the 35 children wo underwent a conservative management. The average stay in the hospital was 11 days in these 35 last patients. No mortality or morbidity were in relation with the conservative management in our series. The exact diagnosis of splenic trauma by ultrasound and scintigraphy allows the pediatric surgeon to choose a non operative treatment, when the child has stable vital signs. Monitoring these patients in intensive care unit is mandatory and allows a careful evaluation of the course of these splenic trauma.