Splenic trauma: Difference between revisions
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**Presence of other injuries and medical comorbidities | **Presence of other injuries and medical comorbidities | ||
*Operative Management | *Operative Management | ||
**Indicated for diffuse peritonitis or hemodynamic instability after blunt trauma | **Indicated for diffuse peritonitis or hemodynamic instability after blunt abdominal trauma | ||
**Not indicated based on injury grade alone<ref>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</ref> | **Not indicated based on injury grade alone<ref>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</ref> | ||
*Nonoperative management | *Nonoperative management | ||
Revision as of 18:26, 16 June 2016
Background
- Most commonly injured visceral organ in blunt trauma
Clinical Features
- 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.
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Diagnosis
ATLS Blunt Abdominal Trauma Algorithm
- Unstable
- Stable
- CT scan
- Exploratory laparotomy, angiographic embolization, conservative management as indicated
- CT scan
AAST Criteria
| 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. |
Management
- 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
Disposition
See Also
References
- ↑ 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