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 InjuryMost 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 IAxial contrast-enhanced computed tomography scan showed subcapsular hemorrhage (arrow) less than 10% of surface area.
Spleen Grade IICT of the abdomen shows a capsular tear 1-3 cm in depth.
Spleen Grade IIICT of the abdomen shows a capsular tear greater than 3 cm in depth.
Spleen Grade IVCT of the abdomen shows laceration involving segmental or hilar vessels producing major devascularisation, greater than 25% of the spleen.
Liver Grade IAxial, contrast-enhanced computed tomography (CT) scan demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma(bruise) less than 1 cm thick.
Liver Grade IIContrast-enhanced CT scan demonstrates a hepatic laceration less than 3 cm in depth in the posterior right hepatic lobe (arrow).
Liver Grade IIIContrast-enhanced CT scan demonstrates a hepatic laceration greater than 3 cm in depth in the posterior right hepatic lobe (arrow).
Liver Grade IVAxial 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.
TreatmentMost 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.
|Grade||PICU days||NPO||Labs||Bedrest||Return to activity||LOS|
|I||0||12 hrs||ED, 12, 18||12 hrs||6 weeks||1 day|
|II||0||12 hrs||ED, 12, 18||12 hrs||6 weeks||1 day|
|III||0||24 hrs||ED, 12, 24, 36||36 hrs||6 weeks||2 days|
|IV||1||24-48 hrs||ED, 6, 12, 24, 48||36 hrs||6 weeks||4 days|
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:
- Pneumovax for pneumococcal infections
- Vaccine for meningococcal infections
- Vaccine for haemophilus influenza type B infections
Pain ControlPain 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 DoctorAfter 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 RestrictionsPlan 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.