Splenic Injury: Trauma Essentials
1. Clinical Presentation
Common in blunt abdominal trauma. Key signs include left upper quadrant (LUQ) pain and left shoulder pain (Kehr’s sign), which occurs due to diaphragmatic irritation by subdiaphragmatic blood.
2. Imaging Characteristics (CECT)
- Lacerations: Irregular, linear, low-density clefts.
- Subcapsular Hematoma: Peripheral, crescent-shaped, low-density fluid collection between the splenic capsule and parenchyma.
- Pseudoaneurysm: A focal “blush” of contrast that follows the contour of the splenic artery; highly prone to delayed rupture.
- Active Extravasation: Contrast “jet” extending beyond the splenic parenchyma.
3. AAST Splenic Injury Scale (Summary)
| Grade | Key Findings |
|---|---|
| I | Subcapsular hematoma <10% surface area; laceration <1cm. |
| II | Hematoma 10-50% surface area; laceration 1-3cm. |
| III | Hematoma >50% or ruptured; laceration >3cm. |
| IV | Segmental/hilar vessel injury with devascularization (>25% spleen). |
| V | Shattered spleen; hilar vascular injury with total devascularization. |
4. Management Strategy
- Non-Operative Management (NOM): Success relies on hemodynamically stable patients. Angioembolization is now frequently used to treat high-grade injuries and preserve splenic function.
- Splenectomy: Indicated for hemodynamic instability or failed NOM. Note: Splenectomy patients require mandatory vaccination (Strep. pneumoniae, H. influenzae, N. meningitidis) due to increased risk of Overwhelming Post-Splenectomy Infection (OPSI).