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
- 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
- Nonoperative management
- Failure rate of 10-15%
- Some advocate nonoperative management only if <55yr and CT injury grade less than IV