A child 14 years of age come to emergency depament with a history of blunt trauma abdomen. On examination Ballance's sign is found to be positive, otherwise the child is stable. Which of the following is not true statement?
As the child is stable, conservative management should be done. " 70% to 90% of children with splenic injury are successfully treated without operation, and 40% to 50% of adult patients with splenic injury nonoperatively in large volume trauma centres". "Splenectomy may be safer option, especially in the unstable patients with multiple potential sites of bleeding. In ceain situations, selective angio embolism of the spleen can play a role''. Splenic injuries are treated nonoperatively, by splenic repair (splenorrhaphy), paial splenectomy, or resection, depending on the extent of the injury and the condition of the patient. Enthusiasm for splenic salvage has been driven by the evolving trend toward nonoperative management of solid organ injury and the rare but often fatal complication of overwhelming postsplenectomy infection (OPSI ). It is uncommon in otherwise healthy adults. For this reason attempts to salvage the spleen are more vigorous. Splenectomy is also indicated for lesser splenic injuries in patients who have developed a coagulopathy and have multiple abdominal injuries, and it is usually necessary in patients with failed splenic salvage attempts. Paial splenectomy can be used in patients in whom only a poion of the spleen has been destroyed, usually the superior or inferior half. Splenic trauma: The spleen is the most commonly injured organ in cases of blunt abdominal trauma. Nonoperative management is the treatment of choice Splenic injuries in children have been managed traditionally without surgery. Until recently, most splenic injuries in the adults were managed with splenorrhaphy or splenectomy. Currently., 50-80% of adults with blunt splenic injuries are managed non operatively. Stable patients who have high-grade splenic injuries on CT or have evidence of ongoing bleeding on CT may be candidate for angiographic embolisation. Unstable patients with splenic injuries should undergo splenectomy or attempts at splenic repair if appropriate. "Ballance's sign: A palpable tender mass can be felt in the left upper quardant with persistent dullness. It is due to extracapsular or subcapsular hematoma (of spleen ) " Splenectomy is usually indicated under the following circumstances: Patient is unstable Other injuries require prompt attention Spleen is extensively injured with continuous bleeding Bleeding is associated with hilar injuries Ref: L & B 25/e, page 348 ; CSDT 11/e, page 253
A palpable tender mass can be felt in the left upper quadrant with persistent dullness
It is due to extracapsular or subcapsular hematoma ( of spleen )
Managed with Conservative treatment
Splenectomy is required