Splenic Contusion and Rupture

If splenectomy is performed, patient will need pneumococcal [A], meningococcal [B], and Haemophilus influenzae (Hib) [B] vaccines; give at or after 14 days for emergency splenectomy, and consider boosters every 5 yrs (5). Also, CDC recommends annual influenza vaccination in the asplenic population.

Need for follow-up imaging is controversial in the clinically improving patient with a nonoperatively managed isolated splenic injury. In pediatric patients engaged in normal age-appropriate activities, follow-up imaging may not be needed after isolated splenic injury (6)[C]. Further research studies may be required to determine if serial imaging is needed, and when, before acceptable return to contact and collision sports.

If indicated clinically, consider follow-up or serial imaging with abdominal CT scan in any age group.

Nonoperative management of stable isolated splenic injuries is appropriate in the majority of patients.

95–99% of pediatric patients with stable isolated splenic injury grades I–IV can be managed nonoperatively (7).

70–90% of adult patients with stable isolated splenic injuries can be managed nonoperatively.

Prior recommendation for return to play was 3 mos, in part based on studies looking at radiographic healing in splenic injuries.

For return to play in pediatric patients, see APSA Guidelines 2000 in “Treatment” section above.

There are no return-to-play guidelines similar to the APSA Guidelines for the adult population; it may be reasonable to use APSA Guidelines in this population as well.

As noted in the APSA Guidelines, return to play for full-contact and collision sports should be based on the individual clinical case and in discussion with the treating physician.