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[Treatment of blunt splenic trauma in children]
F Varlet1, D Tardieu, J Cottalorda
1Service de Chirurgie Pédiatrique, Hôpital Nord, Saint-Etienne.
Insights
Conservative management of blunt splenic trauma in children is safe and effective, avoiding splenectomy and its complications. This approach resulted in a low blood transfusion rate and no immediate or long-term adverse events.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Surgical Outcomes
Context:
- Blunt splenic trauma in children often necessitates surgical intervention.
- Conservative management aims to prevent post-splenectomy infectious complications.
- Evaluating the efficacy and safety of non-operative treatment is crucial.
Purpose:
- To assess the outcomes of conservative management for blunt splenic trauma in pediatric patients.
- To determine the rate of splenectomy and associated complications in conservatively managed cases.
- To analyze transfusion requirements and hospital stay duration in children with blunt splenic trauma.
Summary:
- A 5-year retrospective study analyzed 21 pediatric blunt splenic trauma cases managed conservatively.
- No emergency surgery was required; only 4 children needed secondary procedures for unrelated or incidental findings.
- The study observed a low blood transfusion rate and no immediate or long-term complications, supporting conservative treatment.
Impact:
- Conservative management of blunt splenic trauma in children is a viable and secure option.
- This approach significantly reduces the need for splenectomy, mitigating associated risks.
- The findings support current pediatric trauma guidelines emphasizing non-operative care when feasible.
Unlabelled:
The conservative management of blunt splenic trauma in children has been generally accepted for about twenty years, in order to avoid serious post-splenectomy infectious complications. The objective of this study was to evaluate the results of conservative management.
Patients And Methods:
21 cases of blunt splenic trauma were treated between 1 January 1991 and 31 December 1995. Eleven cases were isolated and 10 were associated with other visceral, musculoskeletal or head injuries. The lesion consisted of subcapsular or intraparenchymal haematoma in 8 cases and ruptured spleen in 13 cases. All children were initially managed conservatively, except in the case of unstable haemodynamic parameters after resuscitation, perforated viscus or secondary complication.
Results:
Emergency surgery for blunt splenic trauma was never required over this 5-year period. Four children required secondary surgery, 2 for left renal lesion, 1 for pancreatic pseudocyst and 1 for epidermoid cyst of the spleen discovered incidentally at the time of the trauma (partial splenectomy). No associated bowel perforations were observed. Four children were transfused, 3 for an associated visceral lesion and only once because of ruptured spleen. The mean length of hospital stay was 18.2 days in the case of isolated rupture and 28.7 days for a ruptured spleen associated with other lesions. No immediate or long-term complications were observed with a mean follow-up of 6 months.
Conclusion:
Conservative management of blunt splenic trauma is possible under good conditions of security and total splenectomy was never required. The blood transfusion rate was very low.