Non operative conservative management of blunt trauma to the spleen in Children: A Single Tertiary Hospital Experience

Abstract

Background: Splenic injury is the leading cause of major bleeding in the patients of blunt abdominal trauma. In earlier medical practice, the blunt splenic injury was managed surgically in most cases, but the increased understanding of the splenic function in the immunological process and the identification of post-splenectomy complications have led physicians to prefer the non-operative management . Material and methods: A retrospective study of the patients with blunt trauma to the spleen in the pediatric age group between the year 2015 and 2018. The study was conducted in (Nasser Institute Hospital for research and treatment). Management of the patients was done using hypovolemic resuscitation and serial follow up. Abdominal ultrasound, complete blood picture and Abdominal CT were done. Data was tabled and analyzed. Results: A total of 123 blunt splenic trauma patients were identified. Traffic-related accident and falling from height were the main mechanisms of injury. Splenic contusion and hematoma were the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen, blush, and devascularization. Non-operative management failed in 6 patients who underwent splenectomy. (95.12%) of the patients managed successfully using hypovolemic resuscitation without need for surgical interference. Discussion: Non-operative management is considered for patients with low-grade splenic injuries, unless operated upon for other associated injuries. In fact, higher-grade injuries could also be managed non-operatively. Splenic angioembolization of bleeding vessels increased the success rate of non-operative management in hemodynamically stable patients. In our study, although we didn`t use splenic angioembolization we were able to reach high rates of success. In comparison with the operative management of blunt splenic trauma, the nonoperative management has the added benefit of preserving the splenic functions. Conclusions: Most blunt splenic trauma patients were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan.