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occasionally reveal a medially displaced gastric bubble. CT scan will identify the
extent of injury ( Figs. 103.4 and 103.5 ).
Management of splenic injuries has evolved during the last three decades since
the recognition of the postsplenectomy sepsis syndrome, resulting from the
influence of both clinical and diagnostic advances. Greater than 95% of splenic
injuries are now managed nonoperatively, with observation or rarely
interventional radiology. The safety of nonoperative management for most
childhood spleen injuries has been well documented, and the incidence of
postsplenectomy sepsis has declined. Findings on CT imaging are important for
determination of when injured children can return to their usual activities.
Follow-up imaging is also rarely necessary.

FIGURE 103.4 Abdominal computed tomography of an 8-year-old boy who was an
unrestrained back seat passenger in a motor vehicle collision. The CT reveals a grade 1 splenic
laceration with mild perisplenic free fluid.