CASE SERIES
MANAGEMENT OF PEDIATRIC SPLENIC TRAUMA IN A RESOURCE-LIMITED TERTIARY CENTER: A FIVE-CASE SERIES

UDK: 616.411-001-053.2

Memeti S.¹, ², Sulejmani H.², Kamiloski M.¹, ², Selmani R.²,³, Isenov O.4, Gavrilovska Brzanov A.4

¹ University Clinic of Pediatric Surgery, Skopje, North Macedonia
² Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
³ University Clinic for Digestive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia

4 University Clinic for Traumatology, Orthopedic Disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Medical Faculty, Ss Cyril and Methodius University, Skopje, Republic of North Macedonia

Memeti Shabanhttps://orcid.org/0000-0001-9797-4001
Sulejmani Harishttps://orcid.org/0009-0002-5583-5489
Kamiloski Marjanhttps://orcid.org/0009-0002-7952-1548
Selmani Rexhephttps://orcid.org/0009-0004-7352-8014
Gavrilovska Brzanov Aleksandrahttps://orcid.org/0000-0001-9593-2502

Abstract

Objective: The aim of this report is to present a five-patient case series of pediatric splenic trauma managed in a resource-limited tertiary center, emphasizing diagnostic pathways, management strategies, and the role of hemoglobin and C-reactive protein (CRP) as practical monitoring biomarkers.

Case Report: Five children aged 3–12 years sustained splenic injury following blunt abdominal trauma caused by traffic accidents, falls, or bicycle-handlebar impact. Injury severity ranged from Grade II to Grade IV. Two patients presented with hemodynamic instability and underwent emergency splenectomy, both of whomdeveloped massive hemoperitoneum and additional intra-abdominal injuries. The remaining three children were hemodynamically stable and were successfully managed non-operatively. All five patients required blood transfusion, with hemoglobin decline serving as the main clinical trigger. Serial CRP measurements demonstrated rapid elevation and faster decline in surgically managed patients, whereas conservatively treated patients showed slower normalization. Imaging relied on targeted abdominal ultrasonography and contrast-enhanced computed tomography, depending on stability. Hospital stays ranged from 5 to 18 days. There were no mortalities or major postoperative complications, and all patients recovered fully.

Conclusion: Non-operative management was safe and feasible in hemodynamically stable pediatric patients, while splenectomy remained necessary for unstable presentations and high-grade trauma. Hemoglobin and CRP trends proved practical, low-cost decision-support tools valuable in settings lacking interventional radiology or advanced trauma infrastructure.

Keywords:non-operative management;pediatric trauma;resource-limited settings; splenic laceration; hemorrhage control.

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