Splenic trauma in children and techniques of splenic salvage

The increased risk of sepsis after splenectomy applies to any age for any reason. Splenic injuries consequently are now managed when possible by salvage procedures or nonoperative observation. This is not without controversy and in an attempt to define these injuries more appropriately and so predict optimal management, a quantitative and qualitative classification of presence and severity is presented, based on computed tomography. Type I injuries consist of localized capsular disruption or subcapsular hematomas, without significant parenchyma injury. Type II injuries consist of single or multiple capsular disruptions, with parenchymal injury that does not extend into the hilum or involve major vessels, with or without intraparenchymal hematoma. Type III injuries consist of deep fractures, single or multiple, that extend into the hilum and involve major vessels. Type IV injuries are those in which the spleen is completely shattered, fragmented, or separated from its normal blood supply. Added to this is the subclassification A for splenic injuries without associated intra‐abdominal injuries; B for splenic injuries with associated intra‐abdominal injuries, B 1 for injuries involving a solid viscus, B 2 for injuries involving a hollow viscus; and E for splenic injuries with associated extra‐abdominal injuries. Surgical techniques for splenic salvage consist of the application of topical hemostatic agents or omentum with or without simple capsular sutures, direct suturing of capsule and parenchyma, ligation of individual or segmental vessels, partial splenectomy, application of an absorbable net or ladder, and large entire organ through‐ and‐through sutures. These techniques are illustrated and alternatives to salvage are discussed.