Splenic fracture resulting from beach injury

A 14-year-old girl was hit by a large wave at the beach. She lost her balance, was tossed around in the water and immediately afterwards became pale and developed generalized abdominal pains and bilateral shoulder pain. On admission there was diffuse abdominal tenderness, with guarding and rebound tenderness. Admission hemoglobin and hematocrit were 10 g/dl and 31% and later fell to 8.7 g/dl and 24.3%. ACT scan of the abdomen showed that there was a splenic fracture and blood in the peritoneal cavity. Such an injury in the past would have been considered to require splenectomy. Treatment of the majority of splenic fractures currently is conservative: provided that the patient remains stable, the standard regimen is hospitalization and bed rest for one week, followed by return home. Children with such splenic injuries are allowed to return to school after one month. Healing is followed by repeated ultrasounds. Contact/collision sports are permitted when healing can be demonstrated to have occurred. This usually takes about 3 to 6 months. Blood transfusions are given sparingly if hemodynamic instability is present in the early stages. Children with EB virus infection or with any disorder that predispose to splenomegaly are more vulnerable to splenic injury.