Complications of splenic injuries: Expansion of the nonoperative theorem

Background/Purpose: Delayed complications (hemorrhages, abscesses, and pseu do-aneurysms) of nonoperative management (NOM) in pediatric spleen injuries are rare but reportedly result in failure of NOM. This study was undertake n to elucidate the rate of delayed complications and their impact on NOM of splenic injuries. Methods: Forty children who underwent NOM of splenic injuries over 5 years were reviewed for complications and success of NOM. All injuries were diagn osed and graded by computed tomography (CT) scans. Follow-up imaging studie s were obtained in all children 6 to 12 weeks postinjury; additional scans also were obtained when clinically indicated. Results: NOM was successful in all children, but 3 (7.5%) had delayed compl ications. A 3 year old with a grade III splenic injury and a distal pancrea tic transection, and a 13 year old with a grade IV injury had pseudoaneurys ms, which were noted on follow-up CT scan (14 days postinjury). The pseudoa neurysms were treated expectantly and resolved spontaneously. A 16 year old (grade IV injury) had a splenic abscess 8 days postinjury that was drained percutaneously with CT guidance. Conclusions Development of delayed complications may not preclude successfu l NOM of pediatric spleen injuries. Splenic artery pseudoaneurysms in child ren appear to resolve spontaneously without intervention. Copyright (C) 200 0 by W.B. Saunders Company.