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
    • 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

Evaluation

Template:ATLS abdominal trauma diagnosis algorithm

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

  1. 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