Pediatric spleen trauma
Introduction
Introduction to spleen trauma in children The spleen is ruptured or torn due to trauma caused by strong vibration, which causes visceral bleeding. Spleen trauma is one of the common clinical emergencies. Not treated in time, often causing shock and death. basic knowledge Sickness ratio: 0.0001% Susceptible people: children Mode of infection: non-infectious Complications: shock
Cause
Causes of spleen trauma in children
(1) Causes of the disease
More common in abdominal blunt injuries or falls, crashes, mostly indirect shocks, rarely direct damage, often a part of serious closed injuries such as falls, bruises, or car accidents, so there are It is possible to diagnose severely obvious trauma such as head injury, multiple fractures, etc., and neglect spleen rupture, or diagnose spleen rupture and ignore other organ damage. The spleen is a substantial organ with a high film tension and a crisp texture. It is an intra-abdominal fixed organ, but there are A certain degree of activity, susceptible to strong vibration and rupture or tear, the normal spleen is not easily injured under the protection of the left rib, but under the strong earthquake, it is still the most easily broken organ in the abdomen. If the spleen is large and has lesions, Especially the hyperemia of the spleen, exposed to the ribs of the season, it is more likely to rupture, abdominal blunt contusion and severe falls and bruises, etc., the incidence of spleen rupture is the first, often accompanied by liver rupture, due to increased disease of the spleen The chance of rupture is higher, and it can be broken due to minor injury that is inadvertent, called "natural rupture of the spleen."
(two) pathogenesis
Because of the high tension of the spleen, it is not easy to close after rupture, so it is easy to stop bleeding, internal bleeding is a prominent pathology, often caused by a large amount of bleeding, because of the thin spleen, lack of connective tissue around the spleen, rupture, blood inflow Free abdominal cavity, it is rare to retain blood clots and cure healing. Even if it temporarily stops bleeding, the possibility of re-bleeding is greater.
Prevention
Pediatric spleen trauma prevention
Strengthen care to prevent all kinds of trauma and accidents.
Complication
Pediatric spleen trauma complications Complications
Often caused by a large number of bleeding, shock, blood volume is insufficient to exceed the compensatory function, it will present comprehensive symptoms of shock. The blood output from the heart is reduced, and although the surrounding blood vessels contract, the blood pressure still drops. Reduced tissue perfusion, promotes anaerobic metabolism, and increases lactic acid and metabolic acidosis. Redistribution of blood flow allows brain and heart supply to be maintained. Further contraction of blood vessels can cause cellular damage. even death. Spleen rupture is often part of a complex injury.
Symptom
Symptoms of spleen trauma in children, common symptoms, refusal to eat, irritability, left abdomen, flexion, abdominal pain, pale bloating, cold sweat
The typical symptom of simple spleen rupture is that after the upper left abdomen is directly hit or severely injured, the child can not stand upright immediately, especially the left abdomen flexion, or even can not stand up, the lying position is left down, the waist is bent forward. Do not dare to move, soon appeared abdominal pain, bloating, poor mental health, refusal to eat, severely pale, cold sweats, irritability and other symptoms of pre-shock.
The palpation of the left upper abdomen has tenderness, percussion dullness, and the diagnosis of abdominal abdomen is the blood abdomen. If the condition of the child is allowed to move, a B-ultrasound examination can show the shape and spleen of the spleen, and can estimate the amount of bleeding and the formation of hematoma. If necessary, the important diagnostic method before surgery, the blood is basically normal in the early stage, and obvious anemia can be seen after more than ten hours.
Because the rupture of the spleen is mostly a part of a complex injury such as a fall or a bruise, it is necessary to perform a systemic examination of each child, including: facial features, neck activity, chest auscultation, limb spine and hematuria, at least after injury. Observe 6h, if necessary, X-ray, CT, MRI, etc., for safety and rapid diagnosis.
If it is considered that the spleen is naturally ruptured or the pathological spleen ruptures, the cause of splenomegaly needs to be further diagnosed in order to cure after hemostasis.
Laparoscopy has little effect in the diagnosis and treatment of spleen rupture. It can only be used in place of laparotomy when the amount of blood is not large.
Examine
Examination of spleen trauma in children
The left upper abdomen palpated with tenderness, percussion dullness, abdominal puncture for the blood abdomen, the diagnosis is basically determined, such as the condition of the child is allowed to move, B-ultrasound can show the shape and spleen of the spleen, and can estimate the amount of bleeding and the formation of hematoma, peripheral The red blood cell count and the amount of hemoglobin decreased progressively. Abdominal B-ultrasound should be performed, and X-ray, CT, MRI, etc. should be performed if necessary.
Diagnosis
Diagnosis and diagnosis of spleen trauma in children
diagnosis
A history of trauma and the above clinical manifestations should be alert to the occurrence of spleen rupture, combined with auxiliary examination can confirm the diagnosis.
Differential diagnosis
Often with the liver rupture, etc., or the previous increase in the spleen, should pay attention to identify whether accompanied by spleen rupture. Liver rupture is a common disease in abdominal trauma, and the right liver ruptures more than the left liver. The liver is located on the right side of the armpit and deep in the ribs, and is susceptible to rupture and bleeding caused by external violence or sharp stab wounds. When the liver is swollen due to a lesion, it is more susceptible to injury when subjected to external force. Hepatic injury often has severe hemorrhagic shock, and bile leakage into the abdominal cavity, causing biliary peritonitis and secondary infection.
