Complications of splenic injuries: Expansion of the nonoperative theorem

Background/Purpose: Delayed complications (hemorrhages, abscesses, and pseudo-aneurysms) of nonoperative management (NOM) in pediatric spleen injuries are rare but reportedly result in failure of NOM. This study was undertaken to elucidate the rate of delayed complications and their impact on NOM of splenic injuries. Methods: Forty children who underwent NOM of splenic injuries over 5 years were reviewed for complications and success of NOM. All injuries were diagnosed and graded by computed tomography (CT) scans. Follow-up imaging studies were obtained in all children 6 to 12 weeks postinjury; additional scans also were obtained when clinically indicated. Results: NOM was successful in all children, but 3 (7.5%) had delayed complications. A 3 year old with a grade III splenic injury and a distal pancreatic transection, and a 13 year old with a grade IV injury had pseudoaneurysms, which were noted on follow-up CT scan (14 days postinjury). The pseudoaneurysms were treated expectantly and resolved spontaneously. A 16 year old (grade IV injury) had a splenic abscess 8 days postinjury that was drained percutaneously with CT guidance. Conclusions Development of delayed complications may not preclude successful NOM of pediatric spleen injuries. Splenic artery pseudoaneurysms in children appear to resolve spontaneously without intervention. Copyright (C) 2000 by W.B. Saunders Company.