Splenic and liver trauma in children.

These data indicate that most children with blunt injury to the liver and spleen can be treated conservatively. The fact that nonoperative management is a successful method of therapy limits the usefulness of DPL in most stable pediatric patients with abdominal trauma. Recovery of blood by DPL will neither influence the decision to operate nor yield information concerning which organ is injured. The abdominal CT scan is the most sensitive diagnostic method. In patients with associated head trauma, the head CT and abdominal CT both can be obtained during the same visit to the radiology suite. DPL may be useful in the unstable patient to be sure the abdomen is the site of bleeding before starting an emergency laparotomy and occasionally, in more stable patients with ongoing abdominal pain, to rule out an associated bowel injury with perforation (e.g., recovery of bilious or feculant material). Insight into the contemporary management of splenic and liver injuries in children is important. In the 1980s, a laparotomy safely can be avoided in many cases with reduction of patient morbidity, length of hospital stay and cost of hospitalization.