A patient with possible blunt trauma to the spleen should be managed based on rapid assessment and available diagnostic studies.
Initial evaluation - Is the patient hypotensive (systolic blood pressure < 90 mm Hg) or tachycardic (heart rate > 112 beats per minute)?
If either of these findings is present, then perform a laparotomy if one or more of the following findings is present:
(1) physical examination (left sided lower rib fractures, left upper quadrant tenderness, referred pain to left shoulder)
(2) positive diagnostic peritoneal lavage (DPL) or
(3) positive FAST (focused abdominal sonography for trauma)
If these tests are negative, then search for other causes of hypotension or tachycardia.
If neither finding is present, then perform CT of the abdomen and pelvis.
Splenic Injury on CT |
Hemoperitoneum |
Management |
Grade 5 |
|
laparotomy |
Grades 3 or 4 |
moderate or large |
laparotomy |
|
none or small |
observe |
Grade 1 or 2 |
large |
consider laparotomy |
|
none, small or moderate |
observe |
none |
|
treat other injuries |
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Gastroenterology
ICD-10: ,