More on the Modern Approach to Diagnostics and Treatment of Spleen Trauma in Children

Today, the problem of spleen injury in children still appears relevant. The choice of diagnostics and treatment tactics at the present stage is far from being unified. The priority direction is the organ-preserving approach, which is possible and justified in children, which significantly reduces surgical aggression and prevents the likelihood of negative consequences of splenectomy. The choice of the optimal diagnostic method and determination of safe treatment tactics was the purpose of our study. Thirty-nine injured children were treated in 2007–2019. The predominant cause of spleen injury was fall from height (64.1%). Echography was the main diagnostic method, which was performed around the clock. Splenectomy was performed in 7 patients (17.9%), in 32 children (82.1%) the organ was preserved. One case (2.6%) was fatal. The analysis of our own results showed that the widespread use of echography, particularly by surgeons, is necessary in the emergency service and greatly simplifies the work. The developed local protocol for diagnosis and treatment is simple and accessible, since it is based on the interpretation of the main criteria, such as systemic hemodynamics and hemoperitoneum. Continued bleeding reasons diagnostic laparoscopy. With unstable hemodynamics, large hemoperitoneum, laparotomy is indicated.

The role of the splenic embolization in blunt spleen trauma.

Resumen Objetivo: describir el caso de un varón que presenta traumatismo abdominal cerrado con lesión esplénica. Material y métodos: paciente de 22 años estable hemodinamicamente tras traumatismo abdominal cerrado, con TAC compatible con lesión esplénica y hemoperitoneo moderado con sangrado activo, tratado mediante embolización arterial. Resultado: evolución tras embolización favorable. Asintomático al año del evento. Discusión: clásicamente se han tratado mediante esplenectomía los pacientes con traumatismo esplénico con sangrado activo y hemoperitoneo. Describimos la utilización de esta técnica como método eficaz en pacientes hemodinamicamente estables. Conclusión: la embolización arterial del bazo es una técnica segura y poco agresiva para el tratamiento de las lesiones traumáticas del bazo en pacientes hemodinamicamente estables con sangrado activo.