Failures in the conservative treatment of transcapsular spleen injuries in children

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: Spontaneous arrest of bleeding from the spleen in children in case of transcapsular injuries is a fact which opens chances for non-surgical injury management. However, continued or delayed bleeding is a risk factor for hemorrhagic shock and conversion to surgery.

AIM: To study the incidence of continued and delayed intraperitoneal bleedings in non-operated spleen injuries in children.

MATERIALS AND METHODS: The prospective cohort study included patients with transcapsular spleen injuries who were hospitalized to the Children’s Clinical Hospital in Irkutsk from March 2002 to December 2022. Failure of the conservative treatment means that there appeared a need for surgical intervention in a child with spleen injury.

RESULTS: Out of 91 patient with spleen injury, surgical interventions were performed in 4 (4.4%) children within the first two hours due to unstable hemodynamics. Non-operative care was originally planned in 87 (95.6%) children, of which 80 (87.9%) cases were successful. Continued and delayed bleeding was observed in 23 children (25.3%). The failure rate in conservative treatment was 8.05% (7 of 87). Main reasons for unsuccessful conservative treatment were continued (n=5; 5.5%) and delayed (n=2; 2.2%) bleeding leading to hypotension.

CONCLUSION: Failures of the conservative treatment of transcapsular spleen injuries in children are associated with continued and delayed intraperitoneal bleeding. The probability of continued bleeding is 5.5%, of delayed one — 2.2%.

Full Text

Restricted Access

About the authors

Ilia A. Pikalo

Irkutsk State Medical University

Author for correspondence.
Email: pikalodoc@mail.ru
ORCID iD: 0000-0002-2494-2735
SPIN-code: 4885-4209
https://mir.ismu.baikal.ru/ismu/page_user.php?id=1862

MD, Cand. Sci. (Medicine)

Russian Federation, Irkutsk

Vladimir V. Podkamenev

Irkutsk State Medical University

Email: vpodkamenev@mail.ru
ORCID iD: 0000-0003-0885-0563
SPIN-code: 7722-5010
https://mir.ismu.baikal.ru/ismu/page_user.php?id=2911

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Irkutsk

Olga A. Karabinskaya

Irkutsk State Medical University

Email: fastmail164@gmail.com
ORCID iD: 0000-0002-0080-1292
SPIN-code: 1511-3402
https://mir.ismu.baikal.ru/ismu/page_user.php?id=4642

MD, Cand. Sci. (Medicine)

Russian Federation, Irkutsk

References

  1. Warwick AM, Jenks T, Fisher R, et al. Disparities in the management of paediatric splenic injury. Brit J Surg. 2019;106(3):263–266. doi: 10.1002/bjs.10996
  2. Grootenhaar M, Lamers D, Ulzen КК, et al. The management and outcome of paediatric splenic injuries in the Netherlands. World J Emerg Surg. 2021;16(1):8. EDN: HLZYQM doi: 10.1186/s13017-021-00353-4
  3. Shinn K, Gilyard S, Chahine A, et al. Contemporary management of pediatric blunt splenic trauma: A national trauma databank analysis. J Vasc Interv Radiol. 2021;32(5):692–702. doi: 10.1016/j.jvir.2020.11.024
  4. Stevens J, Phillips R, Meier M, et al. Novel tool (BIS) heralds the need for blood transfusion and/or failure of non-operative management in pediatric blunt liver and spleen injuries. J Pediatr Surg. 2022;57(9):202–207. doi: 10.1016/j.jpedsurg.2021.09.043
  5. Pikalo IA, Podkamenev VV, Titov EA. Influence of hemoperitoneum in spleen injury on the formation of peritoneal adhesions in intact peritoneum. Kazan Med J. 2022;103(5):870–878. EDN: XWZCLO doi: 10.17816/KMJ2022-870
  6. Aoki M, Abe T, Hagiwara S, et al. Isolated high-grade splenic injury among pediatric patients in Japan: Nationwide descriptive study. J Pediatr Surg. 2021;56:1030–1034. doi: 10.1016/j.jpedsurg.2020.07.011
  7. Yang K, Li Y, Wang C, et al. Clinical features and outcomes of blunt splenic injury in children. A retrospective study in a single institution in China. Medicine (Baltimore). 2017;96(51):e9419. doi: 10.1097/MD.0000000000009419
  8. Jahromi AH, Migliaro M, Romano M, Sangster G. Delayed splenic rupture; normal appearing spleen on the initial multidetector computed tomography (MDCT) can sometimes be misleading. Trauma Mon. 2016;21(5):e24465. doi: 10.5812/traumamon.24465
  9. Shinkai T, Ono K, Masumoto K, et al. A rare mechanism of delayed splenic rupture following the nonoperative management of blunt splenic injury in a child. Surg Case Rep. 2018;4(1):75. doi: 10.1186/s40792-018-0477-5
  10. Notrica DM, Sayrs LW, Bhatia A, et al. The incidence of delayed splenic bleeding in pediatric blunt trauma. J Pediatr Surg. 2018;53(2):339–343. doi: 10.1016/j.jpedsurg.2017.10.005
  11. Acker SN, Ross JT, Partrick DA, et al. Pediatric specific shock index accurately identifies severely injured children. J Pediatr Surg. 2015;50(2):331–334. doi: 10.1016/j.jpedsurg.2014.08.009
  12. Istasy V, Thompson D, Belisle S, et al. The role of point of care ultrasound in the injured paediatric patient. Curr Pediatr Rev. 2018;14(1):41–47. EDN: YJQJHN doi: 10.2174/1573396314666180202102853
  13. Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–196. doi: 10.1097/00005373-197403000-00001
  14. Dehouche N. The injury severity score: An operations perspective. BMC Med Res Methodol. 2022;22(1):1–16. EDN: CHLJVD doi: 10.1186/s12874-022-01528-6
  15. Riley AA, Arakawa Y, Worley S, et al. Circulating blood volumes: A review of measurement techniques and a meta-analysis in children. ASAIO J. 2010;56(3):260–264. doi: 10.1097/MAT.0b013e3181d0c28d
  16. Podkamenev VV, Pikalo IA. Primary prevention of aspleniain cases of injuries of the spleen in children. Pediatriya: Zhurnal imeni G.N. Speranskogo. 2015;94(4):87–92. EDN: UKKCJD
  17. Sinwar PD. Overwhelming post splenectomy infection syndrome: Review study. Int J Surg. 2014;12(12):1314–1316. doi: 10.1016/j.ijsu.2014.11.005
  18. Rumyantseva GN, Kazakov AN, Volkov SI, et al. More on the modern approach to diagnostics and treatment of spleen trauma in children. Sklifosovsky Journal Emergency Medical Care. 2021;10(1):168–173. EDN: FPSVDA doi: 10.23934/2223-9022-2021-10-1-168-173
  19. Ardley R, Carone L, Smith S, et al. Blunt splenic injury in children: Haemodynamic status key to guiding management, a 5-year review of practice in a UK major trauma center. Eur J Trauma Emerg Surg. 2019;45(5):791–799. doi: 10.1007/s00068-018-1014-8
  20. Teuben M, Spijkerman R, Teuber H, et al. Splenic injury severity, not admission hemodynamics, predicts need for surgery in pediatric blunt splenic trauma. Patient Safety Surg. 2020;(14):1. doi: 10.1186/s13037-019-0218-0
  21. Shapkina AN, Kozlova MV, Shmyreva ES, Shumatov VB. How to avoid splenectomy in a child with splenic trauma. Pacific Med J. 2018;(1):72–74. EDN: YTZNFD doi: 10.17238/PmJ16091175.2018.1.72-74
  22. Iglesias PR, Caraballo LR, Jerez MC, Pradas VI. Complications in the conservative management of splenic rupture. Cir Pediatr. 2017;30(4):197–201.
  23. Davis DA, Fecteau A, Himidan S, et al. What’s the incidence of delayed splenic bleeding in children after blunt trauma? An institutional experience and review of the literature. J Trauma. 2009;67(3):573–577. doi: 10.1097/TA.0b013e318190392b
  24. Djordjevic I, Zivanovic D, Budic I, et al. Importance of a follow-up ultrasound protocol in monitoring posttraumatic spleen complications in children treated with a non-operative management. Medicina. 2021;57(8):734. doi: 10.3390/medicina57080734
  25. Pugachev AG, Finkelson EI. Closed injuries of abdominal cavity organs in children. Moscow: Meditsina; 1981. (In Russ).

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Treatment of children with spleen trauma: НОЛ — non-operative treatment; ОЛ — operative treatment; СЭ — splenectomy; СР — splenoraphy.

Download (85KB)
Indexing metadata

Copyright (c) 2023 Pikalo I.A., Podkamenev V.V., Karabinskaya O.A.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies