Objectification of the treatment choice in children with isolated abdominal trauma, ruptured spleen

BACKGROUND: The risk of vital homeostasis disorders and the likelihood of death in patients with spleen injury is determined by organ damage, acute intra-abdominal bleeding, and often hemorrhagic shock.

AIM: This study determines the validity of the clinical criteria for the syndrome of intra-abdominal bleeding, shock, and the argumentation of indications for surgical treatment in the first six hours from the moment of hospital admission in children with an isolated injury, rupture of the spleen.

MATERIALS AND METHODS: The study included 89 patients aged 6 to 12 years with spleen injuries treated at the Republican Children’s Clinical Hospital of the Donetsk People’s Republic from 2014 to 2021. The first subgroup included 61 (68.5%) patients treated conservatively, and the second subgroup comprised 28 (31.5%) operated patients (splenectomy) who initially underwent conservative therapy. Blood pressure and heart rate were controlled, and hemoglobin, hematocrit, erythrocyte, and leukocyte counts were determined. Abdominal echography was performed every three hours.

RESULTS: In assessing the severity of the condition, there were changes in peripheral hemodynamic parameters, such as arterial hypotension and hemoperitoneum with hemorheological disorders (posthemorrhagic anemia of I–II degree, a tendency to thrombocytopenia). In the first six hours from hospital admission, the most objective clinical and laboratory indicators of bleeding and the choice of treatment method were the value of the hemoperitoneum, the level of arterial pressure system, hematocrit, and hemoglobin. No decrease in blood pressure in patients below 100.0 mm Hg, blood hemoglobin of 95.0 g/l with a hemoperitoneum volume of less than 275.0 ml dictated the expediency of continuing conservative therapeutic measures. In cases of deterioration in the condition of patients due to ongoing bleeding with the ineffectiveness of intensive therapy, surgical intervention (laparotomy, splenectomy) is recommended to stop the bleeding.

CONCLUSIONS: In the first hours after injury, the most accurate predictor of the choice of treatment method is the volume of the hemoperitoneum (according to echography), associated with the impaired hemodynamic status of the patient, namely arterial hypotension, which affects choosing a conservative or surgical treatment option.