Hepatic and splenic injury in children: role of CT in the decision for laparotomy

Clinical and radiographic records of 274 children who were examined with abdominal computed tomography (CT) after blunt abdominal trauma were retrospectively evaluated to test the hypothesis that CT can assist in decisions to perform laparotomy in children with hepatic or splenic injury. CT demonstrated parenchymal injuries in 36 patients (13%) or 20 livers and 21 spleens. Injury to these organs was categorized as minor (39%), moderate (39%), and severe (21%) according to an assessment of the percentage of parenchymal involvement. Hemoperitoneum was detected in 27 of 36 patients (75%). One of 13 (4.7%) with a moderate to large splenic injury underwent splenorrhaphy because of persistent bleeding. One of 12 (5%) with a moderate to large hepatic injury required late operative intervention due to a large necrotic segment. Both children had a large amount of peritoneal fluid. Two of 16 patients (13%) with moderate to large hemoperitoneum required surgery for liver or splenic injury. The decision for laparotomy should not be based on the extent of injury as shown at CT but on the physiologic condition of the child.