Lastly, overwhelming post-splenectomy infections (OPSI) are a late cause of complications due to the lack of the immunological function of the spleen. In contrast with liver traumatic injuries, splenic injuries can be fatal not only at the admission of the patient to the Emergency Department (ED), but also due to delayed subcapsular hematoma rupture or pseudoaneurism (PSA) rupture. These considerations were carried out considering the immunological function of the spleen and the high risk of immunological impairment in splenectomized patients. NOM ranges from observation and monitoring alone to angiography/angioembolization (AG/AE) with the aim to preserve the spleen and its function, especially in children. The management of splenic trauma has changed considerably in the last few decades especially in favor of non-operative management (NOM). This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.
In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. At present, they are classified according to the anatomy of the injury. Spleen injuries are among the most frequent trauma-related injuries. World Journal of Emergency Surgery volume 12, Article number: 40 ( 2017) Splenic trauma: WSES classification and guidelines for adult and pediatric patients
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