Successful Treatment of a Child with Combined Injury to the Diaphragm and Spleen in the Central District Hospital

BACKGROUND. Combined injuries to the diaphragm and spleen in children are severe injuries accompanied by massive blood loss and traumatic shock. Successful treatment of this pathology can only be achieved with early diagnosis and timely surgical treatment. We present our clinical observation. DESCRIPTION OF A CLINICAL CASE. We present a clinical case. Child K., 16, was a passenger in a car that collided with another car. On November 20, 2024, after 1 hour 20 minutes, an ambulance team delivered him to the Central District Hospital Tuymazi, of the Republic of Bashkortostan in a serious condition with clinical features of traumatic shock. After a clinical and ultrasound examination, a rupture of the spleen with massive intra-abdominal bleeding, grade III shock was suspected. The patient was taken to the operating room for emergency indications. An upper midline laparotomy was performed under endotracheal anesthesia, under the cover of blood transfusion and blood substitutes. 2500 ml of blood were removed from the abdominal cavity. A grade III-IV rupture of the spleen was diagnosed. Splenectomy was performed with technical difficulties. Upon further revision, a rupture of the diaphragm was found, which was sutured with interrupted U-shaped sutures. The postoperative course is smooth, in a satisfactory condition, he was discharged home after 2 weeks. The patient was examined after 6 months, no complaints. CONCLUSION. This case demonstrates the possibility of successful treatment of diaphragm and spleen injuries in case of combined trauma complicated by shock and massive intra-abdominal bleeding in the central district hospital.