• Liver and splenic lacerations can occur from trauma to certain areas of the tummy, including landing on or being hit in the tummy – often after a car, bicycle or skateboarding accident.
• These injuries cause the liver or spleen to bleed and it is therefore important that we take precautions to minimise this bleeding.
• The liver is a large organ in the tummy sitting on the right hand side under the ribs. The spleen is located on the left side of the tummy under the ribs.

Symptoms 

Your child might:

• complain of stomach or shoulder pain, which would be on the right side of their tummy for a liver injury and the left side of their tummy for a splenic injury
• feel light headed and dizzy
• appear pale and lethargic.

Diagnosis

Your child’s doctor might perform a CT scan of the tummy area.  Sometimes, an ultrasound and X-ray are also required.

Treatment

• Your child will be admitted to the hospital for close observation; the treatment and duration of their stay will depend on the how severe their injury is.
• To help prevent further bleeding, they will be strictly required to stay in bed and rest for a period of time that will be decided by their doctor.  After a period of bed-rest, they will be allowed to slowly get up out of bed and move around the room and then around the hospital.
• The nurses will take regular observations of their heart rate, respiratory (breathing) rate, blood pressure and oxygen levels to monitor for signs of further bleeding.
• They will not be allowed to eat and drink for a period of time and instead will be given intravenous fluids (IV drip).  After a while, they will slowly start to have small amounts to drink, and then can resume eating.  This can be for a number of reasons:
  • to rule out other injuries
  • bleeding from the liver or spleen can irritate the bowel causing it to not work properly for a few days
  • most importantly, in case your child needs an urgent procedure or operation.
• Regular blood tests are required to monitor your child’s haemoglobin level, which will help to find out if their liver or spleen is still bleeding; and electrolytes, which are important to monitor while your child is not eating.
• Your child will be given pain relief as well as some medicine to help if they feel nauseous or are vomiting.

Care at home

• The time of your child’s discharge from the hospital will be based on their level of pain and discomfort, in consultation with the surgical team.
• Continue to offer pain relief as required to keep your child comfortable when at home, however it is important not to give them ibuprofen (Neurofen) or aspirin.
• Even though the chance of the liver or spleen bleeding again is low, it is important to look for signs of bleeding which include:
  •  a recurrence of pain
  • shortness of breath
  • dizziness, fainting, lethargy, a pale appearance.
• Encourage quiet activities at home including watching TV and movies, board games, computer games, reading or crafts.
• Your child will not be able to participate in competitive sports for six to 12 weeks, depending on the degree of their injury.
• It is recommended that your child takes a further one to two weeks off school.  When they return to school, encourage them to take it easy.

Follow up

• Your child will generally be seen at hospital again four to six weeks after they go home, and often an ultrasound will be done at this time.

Key points to remember

• If the doctor says your child is not allowed to eat and drink it is important to discourage this to allow their injury to heal.
• It is important for your child to take it easy at home to limit the chance of further bleeding.

Further information

• Platypus Ward- Surgical Care Unit: (03) 9345 5432

Other RCH Kids Health Info factsheets:

• CT Scan
• Capillary Blood Sampling
• Preparing for hospital – a parent’s guide
• Preparing your child for hospital
• RCH Operation and recovery room

Individual information

Name of your family doctor:___________________________________________________

Phone number:_______________________________________________________