Spleen-saving procedures in paediatric splenic trauma

The aim of this study is to assess the advantages of ‘spleen‐saving procedures’ in paediatric splenic trauma. Since January 1979, 87 children with splenic trauma were treated. Six were treated without operation. Eighty‐one patients were treated surgically. Sixteen cases with type I splenic injury were subject to simple splenorrhaphy, and twenty‐three cases with type II splenic injury underwent splenorrhaphy plus omentoplasty. Twenty‐four cases had type III splenic injury; of these, 20 were treated by ligation of the splenic artery (the main splenic artery in 14 cases and the upper segmental artery in six cases) with splenorrhaphy and omentoplasty, and the remaining four cases were treated by partial splenectomy and omentoplasty. In 16 of the 18 patients with type IV splenic injury, splenectomy was inevitable and heterotopic splenic autotransplantation was added. In the remaining two cases, it was possible partially to preserve the spleen. No complication was observed due to any of these spleen‐saving procedures. Moreover, splenic implants increased complement C3 levels and improved filtration function. Despite other injuries, the mortality rate of this group was 5·7 per cent. The splenic salvage rate was 82 per cent.