Splenic trauma

Background

• Most commonly injured visceral organ in blunt trauma

Clinical Features

• LUQ pain
• Signs of shock
• Hypotension
• Left lower rib pain
• Kehr's sign

Differential Diagnosis

Abdominal Trauma

• Abdominal compartment syndrome
• Diaphragmatic trauma
• Duodenal hematoma
• Genitourinary trauma
• Liver trauma
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture
• Retroperitoneal hemorrhage
• Renal trauma
• Splenic trauma
• Trauma in pregnancy
• Ureter trauma

Diagnosis

Follow ATLS algorithm

• Unstable
  • FAST to search for free fluid (vs. DPL)
    • Exploratory laparotomy if positive
• Stable or FAST negative
  • CT scan

AAST Criteria

• Grade I – Hematoma: subcapsular, <10 percent of surface area. Laceration: capsular tear <1 cm in depth into the parenchyma
• Grade II – Hematoma: subcapsular, 10 to 50 percent of surface area. Laceration: capsular tear, 1 to 3 cm in depth, but not involving a trabecular vessel.
• Grade III – Hematoma: subcapsular, >50 percent of surface area OR expanding, ruptured subcapsular or parenchymal hematoma OR intraparenchymal hematoma >5 cm or expanding. Laceration: >3 cm in depth or involving a trabecular vessel.
• Grade IV – Laceration involving segmental or hilar vessels with major devascularization (ie, >25 percent of spleen) (picture 2).
• Grade V – Hematoma: shattered spleen. Laceration: 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
• Nonoperative management
  • Failure rate of 10-15%
  • Some advocate nonoperative management only if <55yr and CT injury grade less than IV

See Also

• Abdominal Trauma
• Splenic Infarction

References

• Rosens