Splenic rupture due to trauma

Splenic rupture due to trauma

The spleen is the most commonly injured intra-abdominal organ followed by the liver. Splenic rupture should be consid - ered in any case of blunt abdominal trauma, particularly when the injury occurs to the left upper quadrant of the abdomen. Iatrogenic injury to the spleen remains a frequent complication of any surgical procedure, particularly those in the left upper quadrant when adhesions are present. Based upon the extent of injury , spleen rupture is classified into five grades on the basis of CT , which is considered to the most important investigation for assessment of abdominal trauma in a haemodynamically stable patient ( Table 70.1 Vigorous resuscitation remains the key to management of blunt trauma. Splenectomy should be performed for severe grades of injury where control of bleeding takes precedence over measures to salvage the spleen. Splenic angiography with embolisation of actively bleeding vessels may obviate the need for splenectomy but should not delay laparotomy in a haemo dynamically unstable patient.

Figure 70.9 Computed tomography scan showing a splenic infarct (arrows) in a patient with splenomegaly and hypersplenism secondary to portal hypertension and portal vein thrombosis. Varices are evident at the hilus and at the greater curvature of the stomach (arrowheads).