[The present status of treatment of splenic injuries in children].

Small but very dangerous risk of postsplenectomic sepses gave rise to the examination of surgical attitudes of medical treatment of damaged and ruptured spleen. Some new ideas of immunology revealed the importance of the spleen in the protection of the host and serious defect of immunologic system if the spleen is removed. According to those ideas, ruptured spleen is to be retained by all means. Some minor lesions and hemorrhages that are easily controlled by conservative measures, are not to be operated. In case of serious ruptures and massive hemorrhages necessitating more than 20 ml/kg of fresh blood to replace lost volume, penetrated abdominal injuries and with polytraumatic patients, laparotomy, surgical hemostasis and preservation of the spleen are indicated if possible. In the period of the last eight years, 90 children were treated because of the possibility they had injured spleen. Thirty-eight patients (42%) were under observation. Hemodynamic indicators were normal, so we did not make any aggressive diagnostic examinations. Other 47 patients had splenic scintigraphy, computed tomography (CT) of the abdomen or ultrasound examination. The findings were positive with 32 (69%) patients. Of those patients, 14 (44%) were immediately operated since serious rupture of the spleen was diagnosed and clinical signs suggested the presence of severe abdominal bleeding. To this number of operated patients, four polytraumatic patients and one suffering from penetrated injury are to be added. They were indicated the exploration of the abdomen without previous diagnostics. There were 19 surgical treatments of ruptured spleen; three of them included splenectomy while the other patients underwent splenic preservation.(ABSTRACT TRUNCATED AT 250 WORDS)