Physiological Features of the Peritoneum in Non-Operative Treatment of Traumatic Splenic Ruptures in Children

BACKGROUND: Traumatic splenic ruptures are typically associated with intraperitoneal hemorrhage and the formation of hemoperitoneum, which is presumed to initiate adhesion formation and the development of peritoneal adhesions.

AIM: The study aimed to investigate the physiological characteristics of intact peritoneum in the presence of hemoperitoneum and its role in adhesion formation.

METHODS: A cohort study was conducted involving 103 pediatric patients with traumatic splenic rupture. Conservative treatment was applied in 91 (88.3%) children, who underwent serial ultrasound examinations to assess hemoperitoneum volume and resolution timing. Follow-up examinations were performed in 95 (92.2%) children within the first 6 months of life, in 38 (36.9%) aged 6 months to 3 years, and in 10 (9.7%) after the age of 3 years. The experimental part of the study was conducted on 18 Chinchilla rabbits. Hemoperitoneum was simulated by injecting 12–15 ml of autologous blood into the peritoneal cavity. Histological examination of the peritoneum was performed from day 1 to day 30.

RESULTS: The study provided new insights into the physiological properties of intact peritoneum in the presence of hemoperitoneum during nonoperative management of traumatic splenic ruptures in children. The phenomenon of spontaneous hemoperitoneum resorption was observed during nonoperative treatment of traumatic splenic ruptures in children, confirming the feasibility of eliminating intraperitoneal blood without surgical intervention. The median time to disappearance of ultrasound signs of hemoperitoneum was 7 [3; 9] days, with no significant age-related differences (H = 3.18; p = 0.2). A previously unrecognized property of the peritoneum was identified: as long as the mesothelium remains intact, hemoperitoneum does not lead to adhesion formation during nonoperative treatment of traumatic splenic ruptures in children. This anti-adhesive property of the peritoneum suggests the potential for primary prevention of adhesions in the setting of hemoperitoneum.

CONCLUSION: The study highlights the physiological characteristics of intact peritoneum in the presence of hemoperitoneum during conservative treatment of traumatic splenic rupture in children. From a physiological perspective, the intact peritoneum exhibits both anti-adhesive and resorptive properties. Follow-up of children undergoing nonoperative treatment for splenic rupture confirmed the absence of intraperitoneal adhesion formation.