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

• FAST to search for free fluid
• CT scan
• Exploratory laparotomy in unstable pts

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