[Splenic injuries: therapeutic orientation. Apropos of 46 cases].

Between 1979 and june 1983, 46 splenic trauma, with or without associated lesions, have been treated at Sainte'-Justine's Hospital. 8 children had a splenectomy, 3 had a laparotomy for other lesions without a splenectomy was done. 35 had a non operative management of splenic trauma. The ultrasound shows the splenic lesions and the blood in the peritoneal cavity. So, the "Routine Abdominal TAP" does not seem necessary in every abdominal trauma. The splenic scintigraphy is, for, now, the best exam to confirm the diagnosis and to assess the resolution of splenic lesion in 1 to 4 months. Transfusions were done in 8 of 11 operated patients and in 11 of the 35 children wo underwent a conservative management. The average stay in the hospital was 11 days in these 35 last patients. No mortality or morbidity were in relation with the conservative management in our series. The exact diagnosis of splenic trauma by ultrasound and scintigraphy allows the pediatric surgeon to choose a non operative treatment, when the child has stable vital signs. Monitoring these patients in intensive care unit is mandatory and allows a careful evaluation of the course of these splenic trauma.