Nonoperative management of splenic and hepatic
injuries in children is safe, and the majority of those with isolated
injuries do not require
blood transfusion. Thirty-seven children were treated for blunt splenic or hepatic
trauma from November 1983 to September 1989. There was one death in a patient with a lethal
head injury. No operations were performed on those with isolated splenic or hepatic
injuries. Three of those with
multiple injuries underwent delayed
laparotomy. Two had perirenal and retroperitoneal
hematomas without active
bleeding, and one had a bowel obstruction secondary to an intramural jejunal
hematoma. There were no late complications related to the splenic or hepatic
injuries. Eight children (22%) required surgery for other
injuries. Twelve children were not transfused, including the majority (8/11) of those with isolated splenic or hepatic injury. The hematocrit of four of these children fell to below 28% and this
anemia was well-tolerated. Two children with
bleeding disorders (
factor VIII [antihemophilic factor] and
factor XII [
Hageman factor] deficiency) did not require packed red blood cells transfusion. Two clinically distinct groups of children received
blood transfusions: (1) eight patients with
multiple injuries were transfused during initial
resuscitation when unstable or during early operation for other system
trauma (mean, 62.0 mL blood/kg
body weight); and (2) three hemodynamically stable patients with isolated
injuries and 14 stable patients with
multiple injuries were transfused empirically after initial
resuscitation solely because of decreasing blood counts. They received an average of 16.5 and 21.1 mL blood/kg
body weight, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)