Working Diagnosis:
Grade IV splenic laceration with hemorrhagic shock

Treatment:
Exploratory laparotomy with splenectomy

Outcome:
Splenectomy was performed. Post-operatively, the patient was monitored in the ICU for 36 hours where his hemoglobin remained stable and he was subsequently transferred to the floor. The remainder of his hospital course was uncomplicated and he was discharged on post-op day 6. Post-splenectomy vaccines were administered prior to discharge.

He continued to heal well from his exploratory laparotomy and splenectomy and was without specific complaints at follow-up office visits. He was able to return to school approximately 3 weeks following the incident. He was anticipated to return to full activity in 3-6 months.

Editor's Comments:
Repetitive abdominal trauma is always concerning in the setting of high impact sports. Kickers are especially at risk due to their vulnerable position when kicking the ball and are rendered defenseless at that moment. General approach to a young athlete with blunt abdominal trauma is the same as any seriously injured child, which is to address life-threatening injuries that compromises the airway, breathing and circulation. Of note, intraabdominal injury can be onscured by concurrent extraabdominal injury (eg trauma to other anatomical areas such as head, thorax, extremity fractures) that can distract from a significant injury to intraabdominal organs. In addition, in a sport liek football where concomitant head trauma is common, examination may be unreliable due to neurologic status. If patient is hemodynamically stable then he can be manage conservatively by serial abdominal examinations, lab and testing. Ultrasonography via the focused assessment with sonography for trauma (FAST) is useful whenever it is available for rapid and early evaluation of hemodynamically unstable patients with blunt abdominal trauma while CT abdomen and pelvis with contrast is performed in hemodynamically stable patient with clinical findings suggestive of intraabdominal injury. For hemodynamically unstable individuals who are not responsive to fluid resuscitations/transfusions will warrant emergent surgical consultation for possible emergent laparotomy.

References:
Rothrock SG, Green SM, and Morgan, R. Abdominal trauma in infants and children: prompt identification and early management of serious and life-threatening injuries. Part I: injury patterns and initial assessment. Pediatric Emergency care 2000; 16:106

Mooney DP, Rothstein DH, Forbes PW. Variation in the management of pediatric splenic injuries in the United States. J Trauma 2006; 61: 330

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