Liver and Spleen Injury

If your child is hit or falls in a way that causes the left chest, right chest or upper abdomen to hit the spleen or liver, your child may suffer a solid organ injury. Not all spleen and liver injuries are the same. Your child may have a mild bruise or a little tear that causes bleeding; or the spleen/liver may be broken into several pieces.

How Do They Occur?

The spleen and liver are the two most common solid organs that are injured in children.  Most injuries occur during motor vehicle accidents, falls, bicycle accidents, contact sports, and/or violence.

Diagnosing a Spleen Injury

Most children with spleen injuries have abdominal pain after the injury. He or she may also complain of left or right shoulder pain. Your child will be given a physical examination. X-rays, CAT scan (a picture that shows more detail than on x-ray), or blood tests may be done to determine how badly your child's spleen/liver is hurt. Spleen and liver injuries are graded based how they look on the CAT scan. Grade 1 injuries are the smallest while Grade IV injuries are the most severe. Below are examples of CT graded images for diagnosing spleen and liver injuries:y

Spleen Grade I

Axial contrast-enhanced computed tomography scan showed subcapsular hemorrhage (arrow) less than 10% of surface area.

Spleen Grade II

CT of the abdomen shows a capsular tear 1-3 cm in depth.

Spleen Grade III

CT of the abdomen shows a capsular tear greater than 3 cm in depth.

Spleen Grade IV

CT of the abdomen shows laceration involving segmental or hilar vessels producing major devascularisation, greater than 25% of the spleen.

Liver Grade I

Axial, contrast-enhanced computed tomography (CT) scan demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma(bruise) less than 1 cm thick.

Liver Grade II

Contrast-enhanced CT scan demonstrates a hepatic laceration less than 3 cm in depth in the posterior right hepatic lobe (arrow).

Liver Grade III

Contrast-enhanced CT scan demonstrates a hepatic laceration greater than 3 cm in depth in the posterior right hepatic lobe (arrow).

Liver Grade IV

Axial CT image shows a grade IV liver laceration (arrows) involving the right lobe. Posterior pararenal hematoma is adjacent to the bare area (arrowheads) of the liver.

Treatment

Most spleen and liver injuries do not need surgery. Children with the Grade 1-3 spleen/liver injuries are usually admitted to a general floor unit and children with a Grade 4 spleen/liver injury are usually admitted to the ICU (Intensive Care Unit) for 24 hours. Usually, treatment is strict bed rest for 12-36 hours depending on the grade of injury and bedrest ranges from 1-4 days. Other variables such as how long they are not allowed to eat and the number of labs that must be drawn, also vary depending on the grade of the injury.

GradePICU daysNPOLabsBedrestReturn to activityLOS
I012 hrsED, 12, 1812 hrs6 weeks1 day
II012 hrsED, 12, 1812 hrs6 weeks1 day
III024 hrsED, 12, 24, 3636 hrs6 weeks2 days
IV124-48 hrsED, 6, 12, 24, 4836 hrs6 weeks4 days
Sometimes the spleen is seriously injured and won't stop bleeding on its own. If surgery is needed, all efforts are made to save the spleen. Surgery may be a repair to the spleen (splenorrhaphy), removal of part of the spleen (hemisplenectomy), or removal of the whole spleen (splenectomy).

If your child's spleen was so badly damaged that it needed to be taken out, then the protective functions of the spleen were also removed. There are several ways that these can be partially replaced. To help replace the antibody function, your child will need vaccinations about 10-14 days after surgery or before leaving the hospital. They may include:
  1. Pneumovax for pneumococcal infections 
  2. Vaccine for meningococcal infections 
  3. Vaccine for haemophilus influenza type B infections
On the other hand, the liver cannot be removed; therefore all other measures must be taken to treat the injury. Sometimes the surgeons may call Interventional Radiology because they are able to recommend interventions they may perform to stop the bleeding. With the use of their technology, they are able to pinpoint the exact location of bleeding and use items such as stents and catheters to embolize or “clot off” the bleeding. Labs will be obtained as well, as closely monitoring your child to ensure the bleeding has stopped. Occasionally parts of a severely damaged liver need to be removed in the operating room.

Pain Control

Pain is on an individual basis, and therefore treated in that matter. Our goal is to have your child comfortable at all times, therefore appropriate medication will be administered accordingly. For mild pain, children will be given Tylenol, but for those with more severe injuries with greater damage to their bodies, narcotics such as morphine through their IV may be necessary.

When to Call your Doctor

After you leave the hospital, your child will need to be watched for signs of re-bleeding from the spleen or liver. Signs of bleeding include sudden abdominal pain, shortness of breath, dizziness and a fast pulse. You will need to seek medical attention right away if your child has any of these things happen after you leave the hospital.

Activity Restrictions

Plan quiet activities for the first several days at home. Your child does not need to stay in bed, but should walk and play quietly. Your child should not play rough with family, friends, or pets.

Your child should not participate in any activities or sports that involve jumping, climbing, or running such as bike riding, in-line skating, dance, gymnastics, football, basketball, soccer or track.

Activities like gym class and contact sports are not allowed for some time after leaving the hospital. Physical activity and sports are restricted for 6 weeks for all grades (I-IV). All restrictions and activities will be discussed with your child’s surgeon prior to discharge.

Follow up

Follow up with your surgeon will be 2-4 after discharge from the hospital. Usually, no follow-up testing or imaging is needed. Once it is okay for your child to return to normal activity, no further follow-up will be needed.