( this is the spleen of a 6 year old girl in RTA with history of splenomegaly and chronic liver disease who underwent laparatomy after the FAST ultrasonography showed fluid collections in multiple abdominal sites )
A ruptured spleen is the most common source of significant intra-abdominal bleeding in blunt abdominal trauma. Often there are diagnostic hints, such as fractures of lower ribs on the left side.
Given the limited function of the spleen in the adult, a splenic injury resulting in hemodynamic instability or requiring significant blood product transfusion is an indication for splenectomy but in pediatric patients the situation is a bit different as if possible ; splenic conservation should be attempted. Post-operative immunization against encapsulated bacteria is mandatory (Pneumococcus, Haemophilus influenza B, and Meningococcus).
Lesser injuries to the spleen which can be repaired easily are attempted.
