Treatment of blunt splenic trauma in children.

The conservative management nf blunt splenic trauma in children has been ge nerally accepted for about twenty years, in order to avoid serious post-spl enectomy infectious complications. The objective of this study was to evalu ate the results of conservative management. Patients and methods : 21 cases of blunt splenic trauma were treated between 1 January 1991 and 31 Decembe r 1995. Eleven cases were isolated and 10 were associated with other viscer al, musculoskeletal or head injuries. The lesion consisted of subcapsular o r intraparenchymal haematoma in 8 cases and ruptured spleen in 13 cases. Al l children were initially managed conservatively, except in the case of uns table haemodynamic parameters after resuscitation, perforated viscus or sec ondary complication. Results: Emergency surgery for blunt splenic trauma wa s never required over this 5-year period. Four children required secondary surgery, 2 for left renal lesion, 1 for pancreatic pseudocyst and 1 for epi dermoid cyst of the spleen discovered incidentally at the time of the traum a (partial splenectomy). No associated bowel perforations were observed. Fo ur children were transfused, 3 for an associated visceral lesion and only o nce because of ruptured spleen. The mean length of hospital stay was 18.2 d ays in the case of isolated rupture and 28.7 days for a ruptured spleen ass ociated with other lesions. No immediate or long-term complications were ob served with a mean follow-up of 6 months. Conclusion: Conservative manageme nt of blunt splenic trauma is possible under good conditions of security an d total splenectomy was never required. The blood transfusion rare was very low.