Injuries Associated with Splenic Trauma

Renewed interest in conservative nonoperative management of splenic trauma in children led us to review our experience with this injury in 258 patients over the past 5 1/2 years. Blunt trauma was the predominant type of injury, occurring in 241 patients: 80% of these patients had associated extra-abdominal 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 years 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.