What Are Spleen Injuries?
The spleen is located in the upper left area of your belly and sits behind and below the stomach. Most spleen injuries are caused by blunt trauma from a car crash, fall, bike wreck or any other activity that causes a hard blow to the abdomen. A penetrating spleen injury may also result from a gunshot wound or sharp object that tears and cuts the spleen.
What Does the Spleen Do?
The spleen is an important organ in the body, but you can live without it.
- The spleen filters and removes old blood cells and bacteria.
- The spleen also makes red blood cells and is important in helping the body fight infection.
How is a Spleen injury Diagnosed?
Most children with spleen injuries have belly pain after the trauma or injury. They may also complain of left shoulder pain. If a spleen injury is suspected, the trauma surgery providers will carefully examine your child. X-rays, a CT scan (a picture that shows more detail than an X-ray), ultrasound or blood tests may be done.
The American Association for the Surgery of Trauma (AAST) grades spleen injuries on a scale of 1-5. The grade is determined by the size of the injury in the spleen. Grade 1 injuries are the least severe, while grade 5 injuries are the most severe.
How is Spleen Injury Treated?
Most spleen injuries do not need surgery. Children with low grade injuries (1 or 2) may be discharged from the Emergency Department or admitted to the hospital. Higher grade injuries (3-5) will be admitted to the hospital for pain management, blood tests and close monitoring. Depending on the grade of the injury, treatment can include strict bedrest, nothing to eat or drink for a short period of time, pain control, lab work and IV fluid hydration. Blood transfusions may also be necessary.
Sometimes the spleen is so badly injured that it will not stop bleeding on its own. In these rare cases surgery is needed to remove the spleen.
Sometimes the spleen is so badly injured that it will not stop bleeding on its own. In these rare cases, surgery is needed to remove the spleen. If your child has surgery, they will not be allowed to eat after surgery for some time. However, they will be given an IV (a small tube in their vein) for fluid hydration. They may also have a nasogastric tube (a tube through the nose into the stomach) after surgery to keep their stomach empty. Your child will be watched closely for any bleeding in the ICU after surgery for several days, then move to a general care unit as healing continues.
If your child's spleen was so badly injured that it was removed, the protective workings of the spleen were also removed. To help boost the body’s ability to fight viruses, your child will need new vaccinations about 10-14 days after surgery or before leaving the hospital. Your trauma surgery provider and your child’s primary care doctor will decide which vaccines your child will need.
Medications/Pain
Speak to your trauma surgery provider about medicines your child was taking before they were admitted. They will let you know when it is okay to restart home medications. Your child may have some pain or soreness at home. Give acetaminophen (Tylenol®) for pain. Your child's trauma surgery provider may give you a prescription for stronger pain medication. Give the stronger pain medication if the pain does not go away one hour after giving acetaminophen. Follow the directions on the bottle.
Do not give your child ibuprofen (Motrin®, Advil®, Aleve®, etc.) until your trauma surgery provider says that it is okay. Your child may require a stool softener while taking prescription pain medication to prevent constipation and straining with bowel movements.
Wound and Skin Care
Your child may shower or take a tub bath, but may need help for several days after going home. Check with your provider about taking baths if your child had surgery. If your child has cuts or scrapes on the skin from other injuries, wash the areas with warm, soapy water and pat dry. If your child has stitches, follow the specific instructions for caring for them.
Activity after a Spleen Injury
Your child does not need to stay in bed but should walk and play quietly while they heal. Your child should not play rough with friends, family or pets. They may return to school in two to seven days, but your child will be on strict activity restrictions for some time. Strict activity restrictions include no gym, running, activities with wheels, or any activity in which both feet leave the ground at the same time. They should not participate in any competitive/contact sports until the activity restriction time period is over. The length of activity restrictions will depend on the grade of the spleen injury.
Returning to Daycare or School
Your child may require some time off school to be at home to rest. Your trauma surgery provider will give you recommendations about going back to school. If surgery was needed or your child has other injuries, they may be out of school longer. At school, your child should not be taking gym class until the activity restriction time period is over.
Once it is okay for your child to return to normal activity, no further follow-up will be needed. After your child has healed, they are not at an increased risk to hurt their spleen again.
When to Call Your Trauma Surgery Provider
Call the trauma clinic or seek medical attention if your child has:
- Increased or worsening abdominal pain
- Fever higher than 100.5°F
- Difficulty with bowel movements
- Shortness of breath
- Nausea / vomiting
- Dizziness
- A fast heart rate
- Redness, swelling, pus drainage or increased pain around the wound
Emotional Recovery
After the injury, your child may be tired and irritable. It takes time to heal. Use this time for rest and quiet activities. Have your child play board games, read or do small craft projects for short periods of time. Infants and toddlers are harder to distract and will be more difficult to confine, but avoid high-risk activities such as wheeled activities or jungle gyms.
After any trauma, children may experience acute stress symptoms. If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms, please speak with the trauma surgery healthcare provider. Short-term therapy can be provided to help children heal and recover emotionally after a trauma.
Preventive Action
It’s important to teach your child about all types of safety. Unintentional injury is one of the leading causes of death for children in the United States.
At Home: If you have guns in the home, they should be unloaded and locked with a locking device with ammunition stored separately.
At Play: Make sure your child wears the correct type of helmet when riding a bike, using other wheeled toys, or taking part in sports that require helmets.
On the Go: Make sure your child is secured in an age-appropriate child restraint every time they ride in a vehicle. Children under 13 years should not ride in the front seat.
