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 which tears and cuts the spleen.
Function of the Spleen
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.
Diagnosis of Spleen Injury
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, CT scan (a picture that shows more detail than an x-ray), ultrasound or blood tests may be done to help determine how badly your child's spleen is hurt.
The American Association for the Surgery of Trauma (AAST) grades spleen injuries 1-5. The grade is determined by the size of the injury in the spleen and grade 1 injuries are the least severe injuries, while grade 5 injuries are the most severe.
Treatment
Most spleen injuries do not need surgery. Children with the grade 1-4 spleen injuries are usually admitted to the general care unit and children with a grade 5 spleen injury may be admitted to the intensive care unit (ICU). Fortunately, most spleen injuries are treated without surgery. 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 can sometimes 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.
If your child has surgery, he / she will not be allowed to eat after surgery for some time. However, he/she will be given an IV (a small tube in their vein) for fluid hydration. He / she may also have a nasogastric tube (a tube through the nose into the stomach) after surgery to keep their stomach empty.
You child will be watched closely for any bleeding in the ICU after surgery for several days, then moved to the 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 will be necessary for your child.
The vaccines include:
- Pneumovax for pneumococcal infections
- Vaccine for meningococcal infections
- Vaccine for haemophilus influenza type B infections
The pneumovax is repeated every three to five years while the meningococcal vaccine should be given every five years. The haemophilus B vaccine does not need to be given again. Your child may also need to take antibiotics all the time to help the body fight infections. It is important that you tell your doctor or dentist before any procedures that your child's spleen has been removed.
Medications / Pain
Speak to your trauma surgery provider about medicines your child was taking prior to their admission to the hospital and obtain approval to resume home medications. Your child may have some pain or soreness at home. Give acetaminophen (also known as 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 (also known as 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 has 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 on 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 one to two weeks but your child will be on strict activity restrictions for some time. Strict activity restrictions include no gym, running, competitive/contact sports, activities with wheels, or any activity in which both feet leave the ground at the same time. After the initial strict activity time period, he / she should not participate in any competitive / contact sports until instructed by the trauma surgery provider. 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 regarding 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 your trauma surgery provider says it's okay. Your child should leave class five minutes before the other students, to avoid bumping into other children in the halls. Your child should not carry or lift more than one to two textbooks at a time, even if he / she carries a book bag or backpack.When to Call Your Child's Doctor
Call the trauma clinic or seek medical attention if your child has:
- Increased or worsening abdominal pain
- Fever >100.5
- Difficulty with bowel movements
- Shortness of breath
- Nausea / vomiting
- Dizziness
- A fast heart rate
- Concern for wound infection (redness, swelling, pus drainage, or increased wound pain)
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. Try putting your infant or toddler in a large crib or playpen. Ask family and friends to visit, but for short periods of time and not at the same time to minimize activity.
After any surgery children may experience acute stress symptoms that may be reflective of post-traumatic stress disorder (PTSD). If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms please speak with the trauma surgery health care provider. Short term therapy can be provided to help children heal and recover emotionally after a trauma.
Follow-Up / Contact-Us
Usually no follow-up tests are needed, however all children with spleen injuries will be seen in the trauma clinic one or two weeks after discharge. An appointment will be made for you before you leave the hospital, or you will be given a number to call to make an appointment. The trauma clinic number is 513-636-8556.
Once it is okay for your child to return to normal activity, no further follow-up will be needed. After your child has healed, he / she is not at an increased risk to hurt their spleen again.
Preventive Action
It is very important to teach your child about all types of safety. Make sure your child is secured in an age-appropriate child restraint every time they ride in a vehicle. Children under 13 years old are safer in the back seat in the correct child restraint. For questions or to schedule a car seat safety check please call 513-803-7433.
Make sure your child wears the correct type of helmet when riding a bike, using other wheeled toys, or taking part in other active sports.
For more injury prevention tips and resources visit our Comprehensive Children’s Injury Center.
