SPLENIC TRAUMA

Splenic Trauma : Spleen is the most common injured organ in blunt abdominal trauma. Hematologic and immunologic importance of the spleen has changed the attitude of trauma surgeons toward preservation of this organ whenever hemodynamics physiology permits. Massive hemorrhage (> 50 cc/kg weight) and hemodynamic instability are indications for surgery. CT-Scan continues to be the choice of imaging during blunt abdominal trauma to establish the diagnosis of solid organ rupture in blunt abdominal trauma and rule out other major abdominal injuries. Isolated splenic rupture can be managed conservative in almost 80-90% of cases reducing complications and post-splenectomy sepsis. Low velocity of injury, thicker capsule, ribs elasticity and transverse nature of the laceration explain propensity for spontaneous healing in children. Associated lesions are not a contraindication for conservative management. Should conservative management fails the next step is splenography or splenectomy. Child is admitted to intensive care for 48 hours, followed by in-hospital observation until stable to be discharge home. Vaccination (pneumococcus, hemophilus and meningococci) affords added protection. Sonography is helpful for sequential splenic imaging to show when the appearance returns to normal, though clinical exam suffices. Participation in body contact sports should be curtailed for at least three months after injury.