Trauma: Spleen Trauma
Spleen Trauma
Grade II
Grade III 1
Grade IV 2
Grade V 3
Initial Management
- Unstable: Laparotomy
- Diffuse Peritonitis Indicates Bowel Injury & Warrants Laparotomy – Diffuse Peritonitis Should Never be Attributed to Solid Organ Injury as Isolated Hemoperitoneum Should Not Cause Diffuse Peritoneal Irritation
- Transient Responder: Angioembolization
- Stable: CT
- Active Extravasation or Pseudoaneurysm: Angioembolization (90% Success Rate)
- Nonoperative Management Otherwise
- If Angioembolization Fails: Laparotomy
- *Historically Severe Traumatic Brain Injury (TBI) & Altered Mental Status (AMS) Were Considered Contraindications to Nonoperative/IR Management – Now Shown to Be Efficient & Safe
- Was Based on the Fact that Hypotension/Decreased Cerebral Perfusion Pressure is a Significant Risk Factor for Worse Outcomes
Definitive Treatment
- Nonoperative Management: (Poorly Defined)
- ICU & NPO for 24-72 Hours
- Consider Initial Bedrest for 24-48 Hours
- Previously Defined as Injury Grade + One Day (1999 APSA Guidelines)
- Strongly Consider Repeat CT After 2-7 Days, Before Discharge
- Hospital Stay 7-9 Days
- Activity Restriction 1-4 Months
- Some Recommend Return to Normal Activity at Injury Grade + 2 Weeks with Longer Contact Sport Restrictions
- Surgery Management:
- Stable Subcapsular Hematoma: Leave
- Small & Minimal Bleeding: Topical Hemostasis
- Grade II/III: Splenorrhaphy
- Spleen Does Not Hold Suture Well – Consider Pledgets or Absorbable Mesh
- Possibly Consider Partial Splenectomy
- Grade IV/V: Splenectomy
- Vaccinations: *See Spleen: Splenectomy
- *Surgery Solely for Washout of Blood is Generally Not Indicated Unless for Severe Refractory Pain
- *Start DVT Prophylaxis Early (Within 24-48 Hours) for Solid Organ Injury
Mnemonics
Spleen Injury Grading
- I/II/III: 1/2/3 cm Depth
References
- Lam GY, Chan AK, Powis JE. Possible infectious causes of spontaneous splenic rupture: a case report. J Med Case Rep. 2014 Nov 30;8:396. (License: CC BY-4.0)
- Gheju I, Venter MD, Beuran M, Gulie L, Racoveanu I, Carstea P, Iftimie Nastase I, Venter DP. Grade IV blunt splenic injury–the role of proximal angioembolization. A case report and review of literature. J Med Life. 2013;6(4):369-75. (License: CC BY-2.0)
- Best IM. Percutaneous repair of a disrupted left renal artery after rapid stabilization. Clin Pract. 2011 Nov 10;1(4):e116. (License: CC BY-4.0)