Introduction: Spleen injuries account for up to 30% of injuries to the abdominal organs in children. Until recently, surgery with splenectomy has been the only method-of-choice of treating spleen injuries. The risk of early and late postoperative complications, including post-splenectomy, requires implementation of conservative methods of treatment. 

Aim: The analysis of the experience of using the conservative approach in treatment of spleen injuries in children. Materials and methods. The results of treatment of 21 children (16 boys and 5 girls) aged 5-16 years with spleen injury have been analyzed. Home accident caused spleen injury in 3 (14.3%) patients; in 6 (28.6%) patients spleen injury was caused by sport trauma and  in 5 (23.8%) patients by the bike wreck; spleen injury in 7 (33.3%) children was caused by trauma from car accident and they also had combined trauma (traumatic brain injury, bone fractures). All patients were hospitalized within 3 to 36 hours after injury. At the time of hospitalization, the general condition, objective data, hemodynamic parameters, hemogram parameters, radiography data, ultrasound examination, computed tomography were evaluated. In all children, ultrasonography revealed damage to the spleen of I-II degree and signs of hemoperitoneum. Ultrasonography revealed the volume of free fluid in the abdominal cavity ranged from 50 to 270 cm3. In 14 children, damage to the spleen was detected by computed tomography. 

Results: All patients with spleen injury received conservative treatment, including hemostatic, antibacterial and infusion therapy. The condition for the use of conservative tactics was the stability of hemodynamic parameters, as well as the lack of clinical and laboratory data indicating continuous intra-abdominal bleeding. The tactics of “armed waiting” consisted of continuous monitoring of hemodynamic parameters, hemogram parameters, daily ultrasound monitoring and determination of the volume of free fluid in the abdominal cavity. No two-phase ruptures of the spleen were found. In all children on day 5-9 the symptoms of peritoneal irritation regressed, the free fluid in the abdominal cavity was resorbed. The subsequent ultrasound control revealed cicatricial alterations at the site of injury; posttraumatic cyst was developed in one child.

Conclusion: Conservative treatment of spleen injuries is indicated for patients with stable hemodynamic parameters and no signs of continuous intra-abdominal bleeding, provided in the specialized surgical hospital unit with continuous multidisciplinary monitoring.