Splenic preservation in children

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Abstract
The diagnosis of splenic injury can be made with almost 100% certainty by physical examination and nuclear imaging or computerized axial tomography, eliminating the need for surgical exploration in children who are stable and have no evidence of an associated intra‐abdominal injury. The nonoperative approach of treatment has been successful in over 95% of selected cases. Operative splenic preservation methods, including splenorrhaphy with or without splenic artery ligation, hemisplenectomy, and splenectomy with autotransplantation have been attempted and each has a role in the unstable patient requiring operation. Splenectomy alone carries a 1.5% risk of overwhelming postsplenectomy infection which is only partially prevented by Pneumovax® and antibiotics. The regionalization of trauma care in children ensures proper monitoring of the injured child, and a surgeon knowledgeable about the treatment options has made splenic preservation a reality

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