A trial to estimate when to do operative or non-operative management in case of blunt abdominal trauma with splenic injury in pediatric age group.

Document Type : Original Article

Authors

1 Professor of paediatric surgery, General Surgery Department, Faculty of Medicine, Beni-Suef University.

2 Lecturer of paediatric surgery, General Surgery Department, Faculty of Medicine, Beni-Suef University.

3 Demonstrator of paediatric surgery, General Surgery Department, Faculty of Medicine, Beni-Suef University.

4 Lecturer of surgery, General Surgery Department, Faculty of Medicine, Beni-Suef University.

5 Ass. Professor of surgery, General Surgery Department, Faculty of Medicine, Beni-Suef University.

Abstract

Background: The spleen is considered the most affected organ in children with blunt trauma to the abdomen. The most common causes of splenic injury are traffic accident and falling from a height,
The management of blunt abdominal trauma with splenic injury had changed over the past years. Currently, conservative treatment (NOM) is the preferred management for children with splenic injury. Materials and methods: A prospective study included 40 cases with blunt abdominal trauma involving spleen in the pediatric age group from October 2023 till October 2024. The study was conducted in Beni-Suef university hospital. Management of patients was conservatively or operatively according to hemodynamic stability, grades of splenic injury, Injury Severity Score, Shock Index, and presence of other injuries that required laparotomy. Stable patients managed conservatively according to ATLS protocol and regular follow up clinically, and CBC, U\S,and CT with I.V contrast were done. Unstable patients were operated upon.  Results: A total of 40 patients with blunt abdominal trauma with splenic injury were identified, with an average age of (10.70 ±3.98) years old. RTA as a mode of trauma was accounting for (57.5%) of the patients followed by falling from height (40%). CT was done for stable cases. Blood transfusion had been needed in the patients who were managed operatively more than in the patients who were managed non operatively. The initial management of all cases was aiming for stabilization 32 cases (80%) continued conservatively while 8 patients (20%) underwent splenectomy due to failure of resuscitation. Non-operative management had failed in one patient (3.1%) who underwent abdominal exploration and splenectomy. The mortality in the patients who were managed non operatively was zero, while one case was recorded in patients managed operatively. Conclusion: Non-operative management (NOM) had the upper hand in management of cases that responded to initial resuscitation and no substitutional deterioration during conservative management and with low grades of injury for spleen and they represented most of the cases and those with no associated morbidity requiring surgical intervention.

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References

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