Injuries Associated with Splenic Trauma

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Abstract
Renewed interest in conservative nonoperative management of splenic trauma in children prompted a review of experience with this injury in 258 patients over the past 5 1/2 yr. Blunt trauma was the predominant type of injury, occurring in 241 patients: 80% of these patients had associated extraabdominal injuries, predominantly involving the head, chest and extremities; 59% of patients with penetrating trauma had concomitant extra-abdominal injuries, mainly of the thorax. Serious concomitant intra-abdominal injuries requiring operative therapy were found in 36.5 and 94%, respectively, of patients sustaining splenic injury from blunt and penetrating trauma. Children under the age of 16 yr exhibited a similar incidence (32.6 and 100%, respectively). Renal, hepatic, diaphragmatic, intestinal, mesenteric and vascular injuries were most frequent. The pitfall of conservative nonoperative management lies in missing these concomitant serious intra-abdominal injuries. Diagnostic peritoneal lavage is most useful in defining the patients who should undergo exploratory laparotomy, therefore reducing morbidity and mortality secondary to neglected injuries.

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