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[Conservative surgery of splenic trauma in children]
W L Abrantes1, M S de Lucena, M C Schlobach
1Hospital João XXIII da Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte.
Insights
Splenic salvage is a safe and viable option for managing spleen injuries in children, with conservative surgery successful in 70% of cases. This approach avoids splenectomy and preserves immune function in pediatric trauma patients.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Immunology
Context:
- The spleen plays a crucial role in the pediatric immune system.
- Splenectomy can lead to long-term immunologic deficiency.
- Preserving splenic function is a key goal in managing splenic trauma in children.
Purpose:
- To evaluate splenic salvage as a safe therapeutic option for splenic injuries in children.
- To analyze the management strategies and outcomes of splenic trauma in pediatric patients.
Summary:
- A study of 139 children with splenic injuries (aged 5 months to 12 years) found that conservative surgery, including splenorraphy and partial splenectomy, was successful in 71.5% of cases.
- Splenic salvage was feasible in approximately 70% of pediatric splenic injury cases.
- Nonoperative management was considered for hemodynamically stable patients with clear CT findings, while surgery was indicated for associated abdominal injuries.
Impact:
- Highlights the efficacy of splenic salvage in pediatric trauma, reducing the need for splenectomy.
- Provides evidence supporting conservative management strategies for splenic injuries in children.
- Emphasizes the importance of preserving splenic function to prevent post-splenectomy immunologic deficiency.
Abstract:
The spleen is an important component of the immunologic system, especially in children. Splenectomy may result in immunologic deficiency, and splenic salvage is recommended as management in splenic surgery. PURPOSE--Splenic injury management, considering splenic salvage as a safe therapeutic option in these children. METHODS--One hundred and thirty nine (139) children, aged 5 months to 12 years were at João XXIII Hospital, Belo Horizonte, Brazil, for the period of 1981 to 1990. The causes of the trauma, the extent and the management of splenic injuries were evaluated. Hemodynamic instability with shock occurred in 30% of the children. The contusions were responsible for injury in 135 patients (97.2%) with 58.7% caused by pedestrian/motor vehicle accidents 41.6% of splenic injury were grade I and II, 30.6% were grade III, and 26.5 grade IV e V (Injury Scalling Committee). RESULTS--Non operative management was done in 2 patients and 137 were operated on. Conservative surgery was performed in 98 patients (71.5%), which included: splenorraphy in 81 (82.6); partial splenectomy in 10 (10.2%), and laparotomy followed by observation in 7 (7.1%). Post-surgical hemorrhage occurred in one case after conservative surgery. Splenectomy was performed in 39 (28.5%) of the patients with 75-100% of the splenic injury classified in grades IV and V. Multiple associated lesions occurred in 87 children (62.5%). The mortality rate was 10.5%. Cranioencephalic trauma was the cause of death in 13 children. CONCLUSION--The splenic salvage is a possible option in the management of splenic injury in 70% of the cases. Nonoperative treatment of splenic injury depends on the physiologic status of the patient, CT scan demonstration of splenic injury and intensive care management. If there was an associated abdominal injury, there would be an indication for surgery.