Spleen trauma

Reviewed and revised 21 December 2015

OVERVIEW

• Splenic trauma may result from blunt or penetrating abdominal injury
• The spleen is the most commonly injured organ in blunt abdominal trauma

ASSESSMENT

• Abdominal pain, localized tenderness (LUQ)
• Possible hemorrhagic shock
• CT abdomen with IV contrast is the investigation of choice (spleen injuries are graded I to V according to severity)

GRADING

American Association for Surgery of Trauma Organ Injury Scale based on:

• haematoma size (% surface area)
• laceration size (parenchymal depth)
• vessel involvement
• integrity of spleen
• vascular status

Grade          Description of Injury

I                       small (<10%, < 1cm)

II                     moderate (10-50%, < 5cm)

III                    large (>50%, > 5cm or expanding)

IV                     large with partial devascularisation (>25%)

V                      complete devascularisation of spleen

MANAGEMENT

• ATLS approach
• Most haemodynamically stable injuries can be managed non-operatively (especially Grades I to III)
• Injuries involving the hilum or avulsion often require surgery (Grade IV or V)
  — haemodynamic instability is the only real contra-indication to conservative management
• Angiography with embolization should be considered if:
  — a contrast blush is seen on CT
  — AAST grade > III
  — moderate haemoperitoneum is present
  — evidence of ongoing bleeding
• Patients with functional asplenism will need immunisations and follow up similar to post-splenectomy patients

Reference and Links

LITFL

• CCC — Post-Splenectomy Care

FOAM and web resources

• Trauma Professional’s Blog — Delayed Spleen Rupture: Part 1 and Part 2
• Trauma Professional’s Blog — Splenic Vascular Blush
• Trauma Professional’s Blog — Grading Spleen Injuries Simplified
• Trauma Professional’s Blog — EAST Guidelines Update: Spleen Injury
• ED Trauma Critical Care — Blunt Abdominal Trauma Part 1 – The Grading of Splenic Injuries