Conservative management of splenic injury in blunt abdominal trauma

Abstract

T he spleen is one of the most frequently injured organs in blunt abdominal trauma. Motor vehicle accidents are the leading cause of injury to the spleen with pedestrian , bicycle accidents, falls and blunt trauma induced by physical assaults or sports [eg; boxing] as additional common causes. The patient with blunt splenic trauma can present in many ways. The clinical signs and symptoms vary widely. Some patients are asymptomatic and others present in extremis. The introduction and increased availability of new imaging modalities have made the diagnostic process easier. Imaging helps to resolve the uncertainties of diagnosis based on physical signs and clinical judgment. Abdominal ultrasonography especially (FAST) is efficient and can detect interaperitoneal fluid. Patients who are unstable with positive abdominal findings and positive (FAST) require a laparotomy.When (FAST) is negative and the patient is haemodynamically unstable we must search for another source of the haemodynamic unstablility of the patient. In the haemodynamically normalized pateint, when (FAST) is positive and CT is available, we recommend doing CT for detecting the degree of splenic injury and for accurate selection of the proper method of treatment. Splenectomy was the treatment of choice for all splenic injuries. However, During the last decade, improved imaging methods and the demonstrated success of nonoperative treatment for children have increased the frequency of nonoperative management of blunt splenic trauma. Controversy exists about how to appropriately select patients for non-operative treatment since bleeding from splenic injuries can incur significant morbidity and mortality.