Conservative treatment of children with traumatic ruptures of the spleen: results of 22 years of experience

BACKGROUND: Conservative treatment options developed and tested over several decades prevent splenectomy, which leads to post-splenectomy hyposplenism associated with immunodeficiency and hematologic disorders. This article reviews 22 years of conservative management of traumatic splenic rupture, emphasizing the important role of organ preservation and minimizing surgical intervention.

AIMS: The aim was to summarize 22 years of experience in the management of children with traumatic splenic rupture.

MATERIALS AND METHODS: This observational single-center prospective study was conducted from March 2002 to March 2024 at the Ivano-Matreninskaya City Children’s Clinical Hospital in Irkutsk. The medical records of 95 children with traumatic splenic rupture were evaluated. Conservative treatment was received by 83 (87.4%) patients and surgical treatment was received by 12 (12.6%) patients. The age of the affected children was 12 [8; 14] years, with 3.3 times more boys observed (73 vs. 22). For analysis, patients were divided into two groups: comparison group (n = 62; 65.3%) in the early treatment period (March 2002 to August 2012); main group (n = 33; 34.7%) in the late treatment period (September 2012 to March 2024). All children were followed for complications related to spleen injury. Comprehensive follow-up of patients after discharge ranged from 6 months to 15 years.

RESULTS: Of the 95 patients, 2 (2.1%) underwent splenorrhaphy, 3 (3.1%) underwent laparoscopic exploration of the spleen, and 7 (7.4%) underwent splenectomy. Surgical treatment required prolonged combined antibacterial therapy for 13 [10; 16] days. If the spleen was removed after discharge from the hospital, patients were prescribed preventive vaccinations. A discriminant analysis was used to identify cumulative factors that influence the choice of surgical treatment in children with splenic rupture. Combined factors included low systolic blood pressure of 95 (70; 118) mm Hg (p = 0.002); tachycardia with heart rate of 105 [100; 120] beats per minute (p = 0.019); increased shock index of 1.1 [0.9; 1.57] (p = 0.001); blood loss at admission of 13% [6.3; 19] of the circulating blood volume (p = 0.001); maximum degree of blood loss of 2 [1; 3] (p = 0.001). When comparing the groups by duration of treatment, a statistically significant difference was found in the number of days spent in the Surgery Department: the duration of hospital stay was 12 [8; 14] days in the comparison group and 7 (7; 9) days in the main group (p = 0.001). Patients did not differ in terms of blood loss and hemodynamics. Recently, however, the number of surgeries for splenic rupture has decreased 2.6 times, from 16.1% to 6.1%. When evaluating immediate outcomes after splenectomy, it was found that 71.4% (n = 5) of the children had thrombocytosis on day 3–6 after surgery. After spleen removal, all children had an elevated ESR of 25 [23; 39] mm/h for 2 weeks. Long-term results showed that 57.1% of patients had frequent infectious diseases. No symptoms of hyposplenism were observed with conservative management.

CONCLUSIONS: Conservative management of children with traumatic splenic rupture is safe and clinically effective. Non-surgical management can be used in 93.9% of cases. Based on the results obtained, the active use of conservative treatment options for traumatic splenic rupture in children is recommended as the preferred option, with an individualized approach to patient monitoring.