Non-Operative Management of Liver and Spleen trauma in pediatrics referred to Children’s medical center
- سال انتشار: 1398
- محل انتشار: بیست و هفتمین کنگره سالانه انجمن جراحان کودکان ایران
- کد COI اختصاصی: ISMED27_043
- زبان مقاله: انگلیسی
- تعداد مشاهده: 387
نویسندگان
Department of Pediatric Surgery, Children Medical Center, Tehran University of Medical Sciences
Department of Pediatric Surgery, Children Medical Center, Tehran University of Medical Sciences
Department of Pediatric Surgery, Children Medical Center, Tehran University of Medical Sciences
Department of Pediatric Surgery, Children Medical Center, Tehran University of Medical Sciences
چکیده
Introduction:The most common cause of death in pediatrics is trauma. Trauma is the major worldwide public health issue. Due to less soft tissue and immature rib cage and size of solid organs, trauma to solid organs are common in pediatric populations. Mechanisms of solid organ injuries include falling, motor vehicle accident, sport and etc. Management of solid organ Injuries undergone numerous changes in a relatively short time dramatically and recently non operative management of solid organ Injury has been standard of care. We review some cases with non-operative management of solid organ Injury referred to Children s medical center during recent years.Materials and Methods:With retrospective study in Children s medical center we review records of trauma patients in last year between March 2018 to March 2019. There were four spleen injuries with range of 5 to 13 years old and three liver injuries with range of 3 days to 9 years old in liver injuries there were 2 boys and one girl and in spleen injuries were 2 boys and 2 girls.Results:We had 3 Liver and 4 Spleen injuries with variable grades because of being hemodynamically stable and not having simultaneous intra-abdominal injury and no need to further blood transfusion undergone observation and non-operative management. All of them undergone computed tomography (CT) and grading and admitted in ICU with close observation, complete bed rest and monitoring and kept NPOfor first 48 hours. None of them need operation or further intra-abdominal intervention and discharged to home with good condition. Discussion:Trauma is the major public health issue and pediatric trauma is the major problem in child health and responsible for annual mortality. Solid organ Injury is common in pediatric population and recently non operative management has been the standard of treatment according to physiologic status and clinical assessment and no other indication for operation such as simultaneous injury irrespective of grade ofinjury. It is associated with a low overall morbidity and mortality and does not result in increases in length of stay, need for blood transfusions, bleeding complications or visceral associated hollow viscus injuries as compared with operative management. In our center we observed successfully a few patients with variable grades Liver and Spleen injuries without major problem and simultaneous intra-abdominalinjuries and successfully discharged to home with advice to controlled activities according to guidelines and algorithms.Conclusion:According to changing the management protocol in blunt trauma of liver and spleen we recommendnon-operative management of patients with blunt trauma of liver and spleen which are stable in vitalsign and no coexisting injury irrespective of grade of injury.کلیدواژه ها
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