European Journal of Pediatrics

, Volume 172, Issue 9, pp 1187–1190 | Cite as

Comparison of two treatment eras and sonographic long-term outcome of blunt splenic injuries in children

  • Georg SingerEmail author
  • Stefan Rieder
  • Robert Eberl
  • Helmut Wegmann
  • Michael E Hoellwarth
Original Article


The treatment of blunt splenic injuries (BSI) has undergone a significant shift away from an operative approach to a conservative treatment regimen in the last decades. Data concerning long-term follow-up of children sustaining BSI are largely confined to telephone surveys. Children treated with BSI over a 33-year period were analyzed. In order to describe the changing treatment, patients were divided into two groups: group I included children treated between 1977 and 1999; group II children treated between 2000 and 2009. Additionally, patients treated nonoperatively between 2000 and 2009 were invited for a sonographic follow-up examination. In group I 81 patients and in group II 89 patients were treated. An increase of male patients from 69 to 88 % was observed, comparing the two eras. While children treated in the earlier period were 8.8-years-old mean (range 1 to 15), the patients treated between 2000 and 2009 were older (mean 10.4 years, range 1 to 17). Between 1977 and 1999, 79 % of the patients were treated nonoperatively. This rate considerably increased to 94 % in the second era. Follow-up examination was performed with a mean age of 6 years (range 1 to 11 years) post-injury. In 79 % of the cases, the spleen healed without sonographic long-term sequelae. In the remaining 21 % of the patients, a scar formation could be demonstrated.


We were able to confirm that the majority of children sustaining BSI can be safely treated conservatively.


Abdominal trauma Ultrasound Splenic trauma Children 


  1. 1.
    Benya EC, Bulas DL (1996) Splenic injuries in children after blunt abdominal trauma. Semin Ultrasound CT MR 17(2):170–176PubMedCrossRefGoogle Scholar
  2. 2.
    Crankson S (2005) Management of blunt hepatic and splenic trauma in children. Ann Saudi Med 25(6):492–495PubMedGoogle Scholar
  3. 3.
    Davies DA, Pearl RH, Ein SH, Langer JC, Wales PW (2009) Management of blunt splenic injury in children: evolution of the nonoperative approach. J Pediatr Surg 44(5):1005–1008. doi: 10.1016/j.jpedsurg.2009.01.024 PubMedCrossRefGoogle Scholar
  4. 4.
    Ein SH, Shandling B, Simpson JS, Stephens CA, Bandi SK, Biggar WD, Freedman MH (1977) The morbidity and mortality of splenectomy in childhood. Ann Surg 185(3):307–310PubMedCrossRefGoogle Scholar
  5. 5.
    Feigin E, Aharonson-Daniel L, Savitsky B, Steinberg R, Kravarusic D, Stein M, Peleg K, Freud E (2009) Conservative approach to the treatment of injured liver and spleen in children: association with reduced mortality. Pediatr Surg Int 25(7):583–586. doi: 10.1007/s00383-009-2398-7 PubMedCrossRefGoogle Scholar
  6. 6.
    Gauer JM, Gerber-Paulet S, Seiler C, Schweizer WP (2008) Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy. World J Surg 32(12):2730–2735. doi: 10.1007/s00268-008-9733-3 PubMedCrossRefGoogle Scholar
  7. 7.
    Hollwarth M, Breisach G (1978) Conservative therapy of posttraumatic splenic rupture. Chirurg 49(11):711–713PubMedGoogle Scholar
  8. 8.
    Kristoffersen KW, Mooney DP (2007) Long-term outcome of nonoperative pediatric splenic injury management. J Pediatr Surg 42(6):1038–1041. doi: 10.1016/j.jpedsurg.2007.01.039, discussion 1041–1032PubMedCrossRefGoogle Scholar
  9. 9.
    Luks FI, Lemire A, St-Vil D, Di Lorenzo M, Filiatrault D, Ouimet A (1993) Blunt abdominal trauma in children: the practical value of ultrasonography. J Trauma 34(5):607–610, discussion 610–601PubMedCrossRefGoogle Scholar
  10. 10.
    Ma OJ, Kefer MP (2001) Ultrasound detection of free intraperitoneal fluid associated with hepatic and splenic injuries. South Med J 94(1):54–57PubMedGoogle Scholar
  11. 11.
    Mohanta PK, Ghosh A, Pal R, Pal S (2011) Blunt splenic injury in Sikkimese children and adolescents. J Emerg Trauma Shock 4(2):217–221. doi: 10.4103/0974-2700.82209 PubMedCrossRefGoogle Scholar
  12. 12.
    Moore HB, Vane DW (2010) Long-term follow-up of children with nonoperative management of blunt splenic trauma. J Trauma 68(3):522–525. doi: 10.1097/TA.0b013e3181ce1ed5 PubMedCrossRefGoogle Scholar
  13. 13.
    Partrick DA, Bensard DD, Moore EE, Karrer FM (1999) Nonoperative management of solid organ injuries in children results in decreased blood utilization. J Pediatr Surg 34(11):1695–1699PubMedCrossRefGoogle Scholar
  14. 14.
    Potoka DA, Schall LC, Gardner MJ, Stafford PW, Peitzman AB, Ford HR (2000) Impact of pediatric trauma centers on mortality in a statewide system. J Trauma 49(2):237–245PubMedCrossRefGoogle Scholar
  15. 15.
    Sims CA, Wiebe DJ, Nance ML (2008) Blunt solid organ injury: do adult and pediatric surgeons treat children differently? J Trauma 65(3):698–703. doi: 10.1097/TA.0b013e3181574945 PubMedCrossRefGoogle Scholar
  16. 16.
    Stylianos S (2000) Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA Trauma Committee. J Pediatr Surg 35(2):164–7; discussion 167-9.Google Scholar
  17. 17.
    Taylor GA, Sivit CJ (1992) Computed tomography imaging of abdominal trauma in children. Semin Pediatr Surg 1(4):253–259PubMedGoogle Scholar
  18. 18.
    Upadhyaya P, Simpson JS (1968) Splenic trauma in children. Surg Gynecol Obstet 126(4):781–790PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Georg Singer
    • 1
    Email author
  • Stefan Rieder
    • 1
  • Robert Eberl
    • 1
  • Helmut Wegmann
    • 1
  • Michael E Hoellwarth
    • 1
  1. 1.Department of Pediatric and Adolescent SurgeryMedical University of GrazGrazAustria

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