A 7-year-old boy was involved in a motorcycle crash while seated in the back of a minivan without restraints. His vital signs in the emergency room are stable but he is complaining of left upper quadrant abdominal pain. The FAST scan shows scanty fluid around in the left colic gutter. An abdominal and pelvic CT scan with iv and po contrast is performed and the radiologist suggests a "blush" (arterial extravasation) in the splenic parenchyma. The spleen itself sustained a deep parenchymal tear and is classified as a grade III injury. The child remains hemodynamically stable. What is recommended next?
While all blunt abdominal trauma patients developing hemodynamic instability should go to the operating room without delay; in this case it would be more beneficial to perform angio embolization in a hemodynamically stable child. Plain films are of little value unless there is free air, prompting urgent colostomy. If there is no homodynamic instability in this child, every attempt should be made to preserve the spleen and avoid appendectomy. Pneumovax should be given in the perioperative period of a life-saving splenectomy or when significant splenic tissue loss occurred. There is no role for an elective splenectomy in this trauma setting.
Continuous hemodynamic monitoring, celiac angiogram, and Angioembolization of splenic artery.
Immediate exploration in the operation room
If hemodynamic instability develops, aggressive fluid resuscitation including a repeated bolus of 20 mL/kg lactated Ringer's solution followed by a liver spleen scan
Monitoring only
Plastic & Reconstructive Surgery