Regularities of blood resorption during non-operative treatment of children with traumatic injuries of the splen

• Pikalo I.A.
• Podkamenev V.V.
• Karabinskaya O.A.
• Marchenko D.V.
• Izatulin V.G.
• Mikhailov N.I.
• Sharapov I.S.

Abstract

In the field of pediatric trauma, the question of the optimal approach to the treatment of splenic ruptures, with an emphasis on the patterns of hemoperitoneum resorption, has important clinical significance. The phenomenon of spontaneous resolution of hemoperitoneum after conservative treatment of traumatic splenic ruptures in children remains an area of ​​active research. Understanding the timing and factors influencing complete peritoneal blood resorption is critical to improving treatment protocols and prognostic assessments.

Aim. To study the patterns of hemoperitoneum resorption during non-operative treatment of children with splenic ruptures.

Material and methods. A prospective cohort study of 80 children diagnosed with traumatic splenic rupture over the period from 2002 to 2022 was conducted. There were 60 (75%) boys and 20 (25%) girls. The age of the victims was 11 (8; 13) years. The duration of the process of disappearance of blood in the peritoneal cavity was assessed by daily ultrasound. At the same time, the dynamics of changes in the volume of hemoperitoneum was assessed.

Results. The median time for disappearance of ultrasound signs of hemoperitoneum was 7 (4; 10) days. In 96.2% of cases, resorption of hemoperitoneum occurred within 15 days. In one case, hemoperitoneum persisted until the 16^th, 21^st and 30^th days. The timing of blood resorption in the peritoneal cavity did not depend on age (χ²=1.46; p=0.48). At the age of under 6 years, hemoperitoneum resorption was 5.5 (4; 8) days, at the age from 6 to 12 years – 7 (3; 9) days, and at the age over 13 years – 8 (5; 12) days. With a volume of hemoperitoneum up to 11 ml/kg body weight, the time for disappearance of hemoperitoneum was 7 (2; 10) days, with a volume of 11 – 22 ml/kg body weight 8 (6; 12) days, with a volume of more than 22 ml/kg body weight 8 (6; 9) days (χ²=4.67; p=0.097). The longest periods (16–30 days) of blood resorption in the peritoneal cavity were observed with small and moderate volumes.

Conclusion. The resorption time of hemoperitoneum does not depend on the age of the victim or the volume of bloodshed and is 7 (4; 10) days. The disappearance of blood during splenic ruptures in children and the conservative method of treatment depend on the time of aseptic inflammation of the peritoneum. Complete resorption of hemoperitoneum is observed within 30 days after splenic injury, which eliminates the likelihood of intra-abdominal complications and the need to remove blood surgically.

Keywords: splenic injury; children; non-operative treatment; resorption of hemoperitoneum

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