Splenic trauma: Difference between revisions

Revision as of 20:24, 13 June 2019

LUQ pain
Signs of shock
Hypotension
Left lower rib pain
Kehr's sign
- Acute pain in the tip of the shoulder due to the presence of blood in the peritoneal cavity when a patient's legs are elevated while laying flat.

Traumatic rupture of the spleen on contrast enhanced axial CT (portal venous phase).

Splenic hematoma (red arrow) resulting in free abdominal blood (blue arrow).

Unstable
- FAST to search for free fluid (vs. DPL if unavailable)
  - Positive: Exploratory laparotomy
  - Negative: CT scan
Stable
- CT scan
  - Exploratory laparotomy, angiographic embolization, conservative management as indicated

Grade	Hematoma	Laceration
I	Subcapsular, <10% of surface area	Capsular tear <1 cm in depth into the parenchyma
II	Subcapsular, 10-50% of surface area	Capsular tear, 1 to 3 cm in depth, but not involving a trabecular vessel
III	Subcapsular, >50% of surface area OR expanding, Ruptured subcapsular or parenchymal hematoma OR, intraparenchymal hematoma >5 cm or expanding	>3 cm in depth or involving a trabecular vessel.
IV		Involving segmental or hilar vessels with major devascularization (i.e. >25% of spleen)
V	Shattered spleen	Hilar vascular injury which devascularizes spleen.

Observation, angiographic embolization, or surgery depending upon:
- Hemodynamic status of the patient
- Grade of splenic injury
- Presence of other injuries and medical comorbidities
Operative Management
- Indicated for diffuse peritonitis or hemodynamic instability after blunt abdominal trauma
- Not indicated based on injury grade alone^[1]
Nonoperative management
- Failure rate of 10-15%
- Some advocate nonoperative management only if <55yr and CT injury grade less than IV
- Should only be considered in locations with resources available for urgent laparotomy

↑ Stassen N, Bhullar I, Cheng J, et al. Selective nonoperative management of blunt splenic injury: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73(5):s293-s300

Authors:

@@ Line 24: / Line 24: @@
 | align="center" style="background:#f0f0f0;"|'''Laceration'''
 |-
-| I||Subcapsular, <10% of surface area||Capsular tear <1 cm in depth into the parenchyma
+| I||
+*Subcapsular, <10% of surface area
+||
+*Capsular tear <1 cm in depth into the parenchyma
 |-
-| II||Subcapsular, 10-50% of surface area||Capsular tear, 1 to 3 cm in depth, but not involving a trabecular vessel
+| II||
+*Subcapsular, 10-50% of surface area
+||
+*Capsular tear, 1 to 3 cm in depth, but not involving a trabecular vessel
 |-
-| III||Subcapsular, >50% of surface area OR expanding,
+| III||
+*Subcapsular, >50% of surface area OR expanding,
-ruptured subcapsular or parenchymal hematoma
+*Ruptured subcapsular or parenchymal hematoma
+*OR, intraparenchymal hematoma >5 cm or expanding
-OR intraparenchymal hematoma >5 cm or expanding
+||
-||>3 cm in depth or involving a trabecular vessel.
+*>3 cm in depth or involving a trabecular vessel.
 |-
-| IV||||Involving segmental or hilar vessels with major devascularization (i.e. >25% of spleen)
+| IV||||
+*Involving segmental or hilar vessels with major devascularization (i.e. >25% of spleen)
 |-
-| V||Shattered spleen||Hilar vascular injury which devascularizes spleen.
+| V||
+*Shattered spleen
+||
+*Hilar vascular injury which devascularizes spleen.
 |}