Application of non-operative management protocol in pediatric blunt splenic injuries with other associated injuries


  • Mir Fahiem-Ul-Hassan Department of Pediatric Urology, Indira Gandhi Institute of Child Health, Banglore, Karnataka, India
  • Gowhar N. Mufti Department of Pediatric Surgery, Shere Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
  • Mudassir H. Buch Department of Pediatric Surgery, Shere Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
  • Aejaz A. Baba Department of Pediatric Surgery, Shere Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
  • Nisar A. Bhat Department of Pediatric Surgery, Shere Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India



Non-operative management, Blunt splenic injury, Other associated injury


Background: Non-operative management (NOM) has become the standard of care for isolated blunt splenic injuries with satisfactory success rates. However, literature is scarce about the non-operative management of blunt splenic injuries (BSI) with other associated injuries (OAI). The main aim of this study is to assess the applicability of protocol-based NOM in BSI with OAI.

Methods: Protocol based resuscitative algorithm was followed for the management of patients with BSI and OAI. NOM was taken up in those patients who were hemodynamically stable and was not attempted in patients who remained hemodynamically unstable or developed hemodynamic instability even after the resuscitative efforts. The data was collected and analyzed.

Results: Forty patients with the mean age of 7.05±3.9 years were studied. Fall from height formed the commonest mode of injury. The mean AAST grade was 2.55. The most common association was a left lung contusion (20%). Fifteen patients presented with shock among which two failed the protocol-based resuscitative efforts and were hence explored. One of the patients had lung contusion and the other dorsal vertebral fractures (3rd and 4th). Another patient with mesenteric tear and delayed hemorrhage was operated. Two other patients underwent surgical interventions for bowel perforation and fracture of right femur respectively. Spleen was preserved in both of these patients. Though, the NOM was successful in overall 87.5% patients, spleen specific success rate was 92.5%.

Conclusions: Application of protocol-based NOM in patients with BSI with OAI is highly successful if instituted in properly selected patients especially those with low grades of injury and also in those with delayed presentation. 


Dennehy T, Lamphier TA, Wickman W, Goldberg R. Traumatic rupture of the normal spleen: Analysis of eighty-three cases. Am J Surg. 1961;102(1):58-65.

King H, Shumacker HB. Splenic studies: I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136(2):239.

Notrica DM, Linnaus ME. Nonoperative management of blunt solid organ injury in pediatric surgery. Surgical Clinics. 2017;97(1):1-20.

Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R. Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma Acute Care Surg. 2008;64(4):943-8.

Rance CH, Singh SJ, Kimble R. Blunt abdominal trauma in children. J Paediatr Child Health. 2000;36(1):2-6.

Linzer JF, Guyther JE. Abdominal Trauma: What’s New in Assessment and Management. 2016.

Bhasin MK, Nag S. A Demographic Profile of the People of Jammu and Kashmir 1. Population Structure. J Human Ecol. 2002;13(1-2):1-55.

Wani MM, Bali R, Mir IS, Hamadani N, Wani M. Pattern of trauma related to walnut harvesting and suggested preventive measures. Clin Rev Opinions. 2013;5(1):8-10.

Djordjevic I, Slavkovic A, Marjanovic Z, Zivanovic D. Blunt Trauma in Paediatric Patients–Experience from a Small Centre. West Indian Med J. 2015;64(2):126.

Mehall JR, Ennis JS, Saltzman DA, Chandler JC, Grewal H, Wagner CW, et al. Prospective results of a standardized algorithm based on hemodynamic status for managing pediatric solid organ injury. J Am Col Surg. 2001;193(4):347-53.

Hamid R. Is successful non-operative management of isolated pediatric splenic trauma in children possible in an Indian urban hospital. Curr Pedia Res. 2017;21(2).

Streck CJ, Jewett BM, Wahlquist AH, Gutierrez PS, Russell WS. Evaluation for intra-abdominal injury in children following blunt torso trauma. Can we reduce unnecessary abdominal CT by utilizing a clinical prediction model? Journal Trauma Acute Care Surg. 2012;73(2).

Davies DA, Pearl RH, Ein SH, Langer JC, Wales PW. Management of blunt splenic injury in children: evolution of the nonoperative approach. J Pedia Surg. 2009;44(5):1005-8.

El-Matbouly M, Jabbour G, El-Menyar A, Peralta R, Abdelrahman H, Zarour A, et al. Blunt splenic trauma: assessment, management and outcomes. Surgeon. 2016;14(1):52-8.

Jabbour G, Al-Hassani A, El-Menyar A, Abdelrahman H, Peralta R, Ellabib M, et al. Clinical and radiological presentations and management of blunt splenic trauma: a single tertiary hospital experience. Medical Science Monitor: Int Med J Exp Clin Res. 2017;23:3383.

Adams SE, Holland A, Brown J. A comparison of the management of blunt splenic injury in children and young people—A New South Wales, population-based, retrospective study. Injury. 2018;49(1):42-50.

Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5):S288-93.

Thota D, George CK. Quality emergency medical care in India: Challanges and opportunities. Hyderabad: Institute of Health Systems; 2005.

Sharma S. Prehospital Trauma Care. Int J Adv Integrat Med Sci. 2016;(4):158-63.

Giss SR, Dobrilovic N, Brown RL, Garcia VF. Complications of nonoperative management of pediatric blunt hepatic injury: diagnosis, management, and outcomes. Trauma Acute Care Surg. 2006;61(2):334-9.






Original Research Articles