A successful treatment of a child with combined injury to the diaphragm and spleen in a central district hospital

The problem of combined trauma to the thoracic and abdominal organs, including damage to the diaphragm and spleen, is currently becoming more urgent due to the growing number of road accidents. Combined injuries to the diaphragm and spleen in children are severe injuries accompanied by massive blood loss and traumatic shock. A successful management of such pathology can only be achieved with early diagnosis and timely surgical intervention.

Clinical case observation. Child K., 16 years old, was a passenger in a car that collided with another car. On November 20, 2024, the child was admitted to the Central District Hospital in Tuymazi (Republic of Bashkortostan) one hour 20 minutes after the traffic accident. She was in a serious condition with clinical features of traumatic shock. After clinical and ultrasound examination, a rupture of the spleen with massive intra-abdominal bleeding was suspected; the patient had grade III shock. She was taken to the operating room because of emergency indications. An upper midline laparotomy was performed under endotracheal anesthesia and blood transfusion and blood substitutes. 2500 ml of blood were removed from the abdominal cavity. Spleen rapture of grade III–IV was diagnosed. Splenectomy was performed with technical difficulties. Upon further revision, a rupture of the diaphragm was found as well; it was sutured with interrupted U-shaped sutures. Postoperative course was uneventful. In two weeks, the patient was discharged home in a satisfactory state. The repeated examination was made in 6 months, no complaints.

The presented case demonstrates a successful treatment of combined diaphragm and spleen injuries complicated by shock and massive intra-abdominal bleeding in a central district hospital. Only timely diagnostics, early anti-shock and resuscitation steps, as well as surgical intervention have helped to release the patient of a serious condition and to obtain satisfactory results.