Splenic Injury
OVERVIEW Splenic trauma may result from blunt or penetrating abdominal injury The spleen is the most commonly injured organ in blunt abdominal trauma ASSESSMENT Abdominal pain, localized tenderness (LUQ) Possible hemorrhagic shock CT abdomen with IV contrast is the investigation of choice (spleen injuries are graded I to V according to severity) GRADING American Association for Surgery of Trauma Organ Injury Scale based on: haematoma size (% surface area) laceration size (parenchymal depth) vessel involvement integrity of spleen vascular status Grade Description of Injury I small (<10%, < 1cm) II moderate (10-50%, < 5cm) III large (>50%, > 5cm or expanding) IV large with partial devascularisation (>25%) V complete devascularisation of spleen MANAGEMENT ATLS approach Most hemodynamically stable injuries can be managed non-operatively (especially Grades I to III) Injuries involving the hilum or avulsion often require surgery (Grade IV or V) — hemodynamic instability is the only real contra-indication to conservative management Angiography with embolization should be considered if: — a contrast blush is seen on CT — AAST grade > III — moderate hemoperitoneum is present — evidence of ongoing bleeding Patients with functional asplenism will need immunisations and follow up similar to post-splenectomy patients