Non-Operative Management of Isolated Solid Organ Injuries Due to Blunt Abdominal Trauma in Children

Sirs,

We read with great interest the article by Öztürk et al ([3]) where they present their fifteen-year experience in patients with isolated solid organ injuries managed operatively versus non-operatively at their institution. Their conclusion concerning the safety of non-operative treatment in pediatric solid organ injury supports the current concept in blunt abdominal trauma. Furthermore, they have shown that non-operative management significantly reduced the need for blood transfusions and the associated complications.

In the December 1998 issue of the European Journal of Pediatric Surgery, we published our 16-year experience in 174 patients ([1]) which the authors do not refer to in their references. In contrast to the series by Öztürk et al ([3]) but similar to others ([2]), motor vehicle injuries were the prevalent mechanism of injury leading to solid organ injuries in our report. This was associated with a higher incidence of extra-abdominal injuries (60.3 % vs. 32 % in their series), and correlated to a higher rate of mortality (6.8 %), mostly due to associated head injuries. There were no deaths in isolated spleen and/or liver injuries in both operatively and non-operatively managed patients.

In our series, 55 % of the patients required surgical intervention for abdominal solid organ injuries. The relatively high number of surgically managed cases was attributable to more severe injuries we receive as an advanced trauma centre in the region. Blood transfusion requirements were two-fold in surgically managed patients (20.9 ml/kg vs. 39.5 mg/kg; p < 0.05). Increased blood transfusion requirement in surgical patients was thought to be due to manipulation and suturing of the solid organs that aggravates bleeding during surgery as well as the possibility of preoperative bleeding that actually necessitates laparotomy. In the series by Öztürk et al, some of the low grade (Grade I and II) spleen and liver injuries were also managed operatively.

Our conclusion was similar to that of the authors so as to non-operative management reducing the need for blood transfusion in children. On the other hand, procedures such as splenorrhaphy did not seem to be superior to non-operative management in terms of controlling the intraabdominal bleeding, and in contrast could be associated with higher transfusion requirements.

References

• 1 Avanoğlu A, Ulman İ, Ergün O, Özcan C, Demircan M, Özok G, Erdener A. Blood transfusion requirements in children with blunt spleen and liver injuries.  Eur J Pediatr Surg. 1998;  8 322-325
• 2 Gross M, Lynch F, Canty T. et al . Management of pediatric liver injuries: A 13-year experience at a pediatric trauma center.  J Pediatr Surg. 1999;  34 811-817
• 3 Öztürk H, Dokucu A İ, Önen A, Olçu S, Gedik S, Azal O F. Non-operative management of isolated solid organ injuries due to blunt abdominal trauma in children: a fifteen-year experience.  Eur J Pediatr Surg. 2004;  14 29-34