SPLEEN TRAUMA

Management of spleen (closed) trauma

· Spleen trauma in the majority of cases can be managed

with non operative management.

· A patient with spleen trauma unstable goes for a FAST, if is

positive then goes for operating room

· A patient with spleen trauma stable goes for a CT, if there is

bleeding or if the score of spleen injury is III or more, then the

angioembolization or the surgery is indicated.

The decision to employ the NOM pathway for

blunt splenic injury requires the patient to meet several

criteria. The first and foremost is hemodynamic

stability with the absence of any suspected associated

intra-abdominal injury

Certainly there are several clear absolute

contraindications which include the patient who is

receiving or will receive systemic anticoagulation.

Special consideration is in order for injured pregnant

women with viable preterm fetuses who would not

tolerate the stress of NOM failure. Also the patient

with multiple injuries or traumatic brain injury with

a mid to high grade splenic injury poses a particular

challenge to NOM.

The question of where to admit should be based

on injury grade. It is our institutional practice to admit

all injuries grade III or above to the intensive care unit.

Grade I and II injuries can be admitted to a less intensive

monitored setting. Certain grade I injuries may not

require admission and observation, but always while

taking into account that CT is notorious for underestimating

injury. The period of observation is debatable

and the clinical condition and progress of the patient

should play a role in deciding duration. Multiple studies

have concluded that most failures of NOM occur in

the first 72 hours of admission. Smith and colleagues

suggest that if hematocrit and pulse are stable after 48

hours, then patients can be ambulated and fed.8 The

hematocrit should be checked frequently for high grade

injuries and less frequently for grade I and II injuries