A Dangerous Ride: A Case of Traumatic Splenic Rupture
A
9-year-old boy in reduced clinical condition presented to the emergency department with acute abdominal pain after having been kicked by a horse on the left flank during riding lessons. The patient’s past medical history included hereditary spherocytosis with recurrent episodes of splenic enlargement. Clinical examination revealed an ecchymosis along the left flank (Figure 1), a tense and tender abdomen, and positive Kehr sign. Ultrasonography detected a capsular splenic hematoma and ascites. Computer tomography showed laceration of the spleen and an injury of the cranial pole of the left kidney with intraparenchymal and abdominal hematoma (Figure 2; available at www.jpeds. com). The patient subsequently developed tachycardia, pallor, clammy skin, cold extremities, and somnolence. Hemoglobin dropped from initially 116 g/L to 69 g/L. Surgical spleen removal revealed parenchymal laceration, dividing the organ into two segments (Figure 3). Splenic rupture is an emergency condition in pediatrics and can be traumatic or spontaneous. Most common trauma in children include motor vehicle collisions, falls, bicycle accidents, or sports-related injuries. Children with known splenomegaly, for instance due to infectious mononucleosis or hematological disorders, are at high risk even after a minor blunt abdominal trauma, and should be monitored meticulously.1 n
Figure 3. Spleen divided into two fragments.
Eleni Z. Giannopoulou, MD Ludwig Gortner, MD Department of Pediatrics and Neonatology
Clemens-Magnus Meier, MD Department of General Surgery, Visceral, Vascular, and Pediatric Surgery Section of Pediatric Surgery
Sascha Meyer, MD Department of Pediatrics Section of Neuropediatrics University Hospital of Saarland Homburg/Saar, Germany
Reference 1. Lynn KN, Werder GM, Callaghan RM, Sullivan AN, Jafri ZH, Bloom DA. Pediatric blunt splenic trauma: a comprehensive review. Pediatr Radiol 2009;39:904-16.
Figure 1. Ecchymosis along the left flank.
J Pediatr 2015;167:202. 0022-3476/$ - see front matter. Copyright ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2015.04.030
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Vol. 167, No. 1 July 2015
Figure 2. Laceration of the spleen in computer tomography.
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A
9-year-old boy in reduced clinical condition presented to the emergency department with acute abdominal pain after having been kicked by a horse on the left flank during riding lessons. The patient’s past medical history included hereditary spherocytosis with recurrent episodes of splenic enlargement. Clinical examination revealed an ecchymosis along the left flank (Figure 1), a tense and tender abdomen, and positive Kehr sign. Ultrasonography detected a capsular splenic hematoma and ascites. Computer tomography showed laceration of the spleen and an injury of the cranial pole of the left kidney with intraparenchymal and abdominal hematoma (Figure 2; available at www.jpeds. com). The patient subsequently developed tachycardia, pallor, clammy skin, cold extremities, and somnolence. Hemoglobin dropped from initially 116 g/L to 69 g/L. Surgical spleen removal revealed parenchymal laceration, dividing the organ into two segments (Figure 3). Splenic rupture is an emergency condition in pediatrics and can be traumatic or spontaneous. Most common trauma in children include motor vehicle collisions, falls, bicycle accidents, or sports-related injuries. Children with known splenomegaly, for instance due to infectious mononucleosis or hematological disorders, are at high risk even after a minor blunt abdominal trauma, and should be monitored meticulously.1 n
Figure 3. Spleen divided into two fragments.
Eleni Z. Giannopoulou, MD Ludwig Gortner, MD Department of Pediatrics and Neonatology
Clemens-Magnus Meier, MD Department of General Surgery, Visceral, Vascular, and Pediatric Surgery Section of Pediatric Surgery
Sascha Meyer, MD Department of Pediatrics Section of Neuropediatrics University Hospital of Saarland Homburg/Saar, Germany
Reference 1. Lynn KN, Werder GM, Callaghan RM, Sullivan AN, Jafri ZH, Bloom DA. Pediatric blunt splenic trauma: a comprehensive review. Pediatr Radiol 2009;39:904-16.
Figure 1. Ecchymosis along the left flank.
J Pediatr 2015;167:202. 0022-3476/$ - see front matter. Copyright ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2015.04.030
202
Vol. 167, No. 1 July 2015
Figure 2. Laceration of the spleen in computer tomography.
202.e1
