Multimodality management in severe pediatric spleen trauma.
BACKGROUND: Trauma is the leading cause of death in children. In abdominal lesions the spleen is the most commonly involved organ. During the last two decades much effort has focused on spleen tissue conservation. OBJECTIVES: To analyze the rationale of a multimodality management policy that includes autotransfusion and mesh wrapping. METHODS: Data gathered over 14 years illustrate the introduction of new techniques and their impact on cases of severe spleen rupture. RESULTS: A total of 122 children were treated during the 14 year period, 1985-98. In 16 children an absorbable mesh wrapping, alone or in combination with other techniques, was used to obtain hemostatis and save spleen tissue. CONCLUSIONS: Mesh wrapping, partial splenectomy and autotransfusion can be used, alone or in combination, to preserve severely injured spleens. According to our records, all children survived with a functional spleen. There were no cases of rebleeding. In only one case of prolonged postoperative fever could the cause be traced to an infected spleen hematoma that was drained transcutaneously. Autotransfusion is performed simply and without the use of a "cell saver." Its use can be crucial in small or field hospitals or in a situation of mass casualty.