الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Spleen is a vulnerable organ and frequently sustains injury from
the abdominal trauma in pediatrics and in all age groups. Frequency of
splenic injury due to blunt trauma far exceeds than that due to other
causes.
After blunt injury to the spleen, splenectomy was the preferred
method of management till late seventies. Contemplations for the splenic
salvage operations and nonoperative treatment for splenic injuries was
increasingly been suggested for its invaluable functions. Splenic salvage
is concepted when overwhelming sepsis in patients after splenectomy is
reported.
The idea of nonoperative treatment of selected pediatric patients
with splenic injury was introduced in 1968. Still, it was not until the
development of better diagnostic modalities in two subsequent decades
that nonoperative management (NOM) became a more common treatment
strategy in patients.
Currently, the standard of care for a hemodynamically stable
patient with a splenic injury documented by computed tomography scan
is nonoperative treatment with close monitoring by an experienced
surgical team.
Morbidity and mortality are further compounded by the life-long
risk of overwhelming postsplenectomy sepsis that is estimated to occur
85 times the rate of the normal population Even in regions with organized
trauma systems, a significant number of children are likely managed at
the general hospitals.
The objective of the early selective splenic arterial embolization is
to improve the results of nonsurgical management proximal embolization
has recently been used more extensively than distal embolization
Splenorrhaphy has become increasingly used for management of
the traumatized spleen.It can be done with Direct sutures of the splenic
parenchyma application of omentum or topical haemostatic agent with or
without simple capsular sutures, Ligation of segmental vessels at the
hilum or application of absorbable sutures (ladder or net either vicryl or
Dixon).
Surgical techniques for splenic preservation (partial splenectomy and
reimplantation) and perioperative pneumococcal vaccination are thought
to decrease the risk for overwhelming pneumococcal sepsis syndrome in
asplenic patients.