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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 splenic laceration with mild perisplenic free fluid