Failures in the conservative treatment of transcapsular spleen injuries in children

Abstract

BACKGROUND: Spontaneous arrest of bleeding from the spleen in children in case of transcapsular injuries is a fact which opens chances for non-surgical injury management. However, continued or delayed bleeding is a risk factor for hemorrhagic shock and conversion to surgery.
 AIM: To study the incidence of continued and delayed intraperitoneal bleedings in non-operated spleen injuries in children.
 MATERIALS AND METHODS: The prospective cohort study included patients with transcapsular spleen injuries who were hospitalized to the Children’s Clinical Hospital in Irkutsk from March 2002 to December 2022. Failure of the conservative treatment means that there appeared a need for surgical intervention in a child with spleen injury.
 RESULTS: Out of 91 patient with spleen injury, surgical interventions were performed in 4 (4.4%) children within the first two hours due to unstable hemodynamics. Non-operative care was originally planned in 87 (95.6%) children, of which 80 (87.9%) cases were successful. Continued and delayed bleeding was observed in 23 children (25.3%). The failure rate in conservative treatment was 8.05% (7 of 87). Main reasons for unsuccessful conservative treatment were continued (n=5; 5.5%) and delayed (n=2; 2.2%) bleeding leading to hypotension.
 CONCLUSION: Failures of the conservative treatment of transcapsular spleen injuries in children are associated with continued and delayed intraperitoneal bleeding. The probability of continued bleeding is 5.5%, of delayed one — 2.2%.