Current management of liver and splenic blunt trauma in children

Thirty-nine children with blunt liver and/or splenic injury were treated in our department from 1979 to 1987; 23 had a splenic injury, 10 a hepatic injury, and the remaining 6 had both. The diagnosis was suggested by the history and physical examination and was confirmed by CT and radioisotope scanning. Every hemodynamically stable patient was initially managed non-operatively. The children who failed to respond to conservative treatment and had unstable vital signs indicating intractable hemorrhage were eventually operated upon. Every effort was made to preserve the liver and spleen during the operation. Liver repair, splenorraphy alone or in combination with splenic artery ligation, and autotransplantation of splenic tissue were widely used procedures. Sixteen patients were successfully managed nonoperatively, but the remaining 23 required surgery. Only 5 children became completely asplenic and no liver lobe resection was performed. It is suggested that conservative management of children with liver and/or splenic injury is both safe and effective. When surgical intervention is inevitable great effort should be made to preserve liver and spleen.Presented at the XII International Congress of Greek Association of Paediatric Surgeons in Rhodes, 1987Offprint requests to: G. Tryfonas