Splenic Trauma

Splenic injury is a frequent complication of blunt trauma and is graded into:

• Grade I
  • Subcapsular haematoma <10% of surface area
    Lenticular perisplenic collection.
  • Parenchymal laceration <1cm deep
  • Capsular tear
• Grade II
  • Subcapsular haematoma 10-50% of surface area
  • Parenchymal laceration 1-3cm deep
  • Intraparenchymal haematoma <5cm
• Grade III
  • Subcapsular haematoma >50%
  • Ruptured haematoma ≥5cm
  • Parenchymal laceration >3cm deep
• Grade IV
  • Splenic vascular injury
  • Active splenic capsular bleeding
  • Parenchymal laceration involving segmental or hilar vessels
• Grade V
  • Shattered spleen
  • Splenic vascular injury with bleeding into peritoneum

Injuries involving the hilum (grade IV-V) usually require intervention; most others can be managed non-operatively.

Epidemiology and Risk Factors

Pathophysiology

Aetiology

Clinical Manifestations

Diagnostic Approach and DDx

Investigations

Bedside:

Laboratory:

Imaging:

Other:

Management

• Intervention depends on grade of injury and haemodynamic stability
• Non-operative management is appropriate for low-grade injury

Resuscitation:

Specific therapy:

• Pharmacological
• Procedural
  • Angioembolisation
  • Splenectomy
    • Unstable and proceeding to laparotomy
• Physical

Supportive care:

Disposition:

Preventative:

Management of asplenia is covered in more detail under Asplenia.

• Prevention of post-splenectomy infection
  Vulnerability to infection by encapsulated organisms. Recommendations for:

  • Spleen registry referral
  • Vaccination
    • Pneumococcal
    • H. influenzae type B
    • Meningococcal
    • Influenza
  • Prophylactic antibiotics

Marginal and Ineffective Therapies

Anaesthetic Considerations

Complications

Prognosis

Key Studies

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References

1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.