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- The spleen is formed by reticular and lymphatic tissue and is the largest lymph organ.
- The spleen lies posterolaterally in the left upper quadrant (LUQ) between the fundus of the stomach and the diaphragm.
- The spleen is the most commonly injured intra-abdominal organ:
- In nearly 2/3 of cases, it is the only damaged intraperitoneal structure
- Blunt mechanisms are more common
- Motor vehicle accidents (auto–auto, pedestrian–auto) are the major cause (50–75%), followed by blows to the abdomen (15%) and falls (6–9%)
- Mechanism of injury and kinematics are important factors in evaluating patients for possible splenic injury.
- Splenic injuries are graded by type and severity of injury [American Association for the Surgery of Trauma (AAST) criteria]:
- Grade I:
- Hematoma: Subcapsular, <10% surface area
- Laceration: Capsular tear, <1 cm in parenchymal depth
- Grade II:
- Hematoma: Subcapsular, 10–50% surface area; intraparenchymal, <5 cm in diameter
- Laceration: Capsular tear, 1–3 cm in parenchymal depth and not involving a trabecular vessel
- Grade III:
- Hematoma: Subcapsular, >50% surface area or expanding, ruptured subcapsular or parenchymal hematoma; intraparenchymal hematoma, ≥5 cm or expanding
- Laceration: >3 cm in parenchymal depth or involving the trabecular vessels
- Grade IV:
- Laceration: Involving the segmental or hilar vessels and producing major devascularization (>25% of spleen)
- Grade V:
- Laceration: Completely shattered spleen
- Vascular: Hilar vascular injury that devascularizes the spleen
- Grade I:
- Poorly developed musculature and relatively smaller anteroposterior diameter increase the vulnerability of abdominal contents to compressive forces.
- Rib cage is extremely compliant and less prone to fracture in children but provides only partial protection against splenic injury.
- Splenic capsule in children is relatively thicker than that of an adult; parenchyma of spleen seems to contain more smooth muscle than in adults.
- Significant abdominal injury occurs in only about 5% of child abuse cases but is the 2nd most common cause of death after head injury.