Universidad de Guadalajara

November 2011

Spleen Trauma

Centro Universitario Ciencias de la Salud

Giovanna Lazcano Sherman

Dr. Héctor Manuel Virgen Ayala

Dr. Benjamín Robles Mariscal

Anatomy

Develops from mesenchymal

cells in the dorsal mesogastrium during the fifth

week of gestation.

The

peritoneum covering the

spleen, except in the hilum.

7cm

12 cm

3 – 4 cm

150 gr. (80 -300 gr).

Ligaments • Splenophrenic • Splenocolic

• Gastrosplenic• Splenorenal

Irrigation and venous drainage

Histology/Physiology

Splenic Trauma/Injury

The spleen is the intra-abdominal

organ most frequently

injured in blunt trauma.

History of a blow, fall, or

sports-related injury

Splenic injury…

Splenectomy

Was considered the only

acceptable surgical option for splenic injuries.

Recently, nonoperative management have been considered adequate

options in patients

postsplenectomy syndrome

Overwhelming postsplenectomy infection (OPSI)

• Sudden onset of symptoms.• Rapid and fulminating course (12 to 18 hours).• Fever.• Nausea.• Vomiting.• Headache.• Altered mental status.

Is complicated by shock, electrolyte imbalance,

hypoglycemia, and disseminated intravascular

coagulation.

Mortality 50% to 80%

polyvalent pneumococcal vaccine

The diagnosis is confirmed by

ECO - CT (hemodynamic

stability) or exploratory laparotomy

(hemodynamic instability)

70%Nonopertative Treatment

• Hemodynamic stability. • Normal abdominal examination.• Absence of contrast extravasation on CT. • Absence of other clear indications for exploratory

laparotomy or associated injuries requiring surgical intervention.

• Absence of associated health conditions that carry an increased risk for bleeding (coagulopathy, hepatic failure, use of anticoagulants, specific coagulation factor deficiency)

• Injury grade I to III.

Surgical treatment of a

splenic injury depends on its

severit the presence of shock, and

associated injuries.

Organ Injury Scaling-American Association of the Surgery of Trauma (OIS-AAST)

From

Moo

re E

E, C

ogbi

ll TH

, Jur

kovi

ch G

J, et

al:

Org

an in

jury

sca

ling:

Spl

een

and

liver

(1

994

revi

sion

). J T

raum

a 38

:323

-324

, 199

5, w

ith p

erm

issi

on.

Grade Injury Description

I Haematoma: Subcapsular, <10% surface areaLaceration: Capsular tear, <1cm parenchymal depth

II Haematoma: Subcapsular, 10-50% surface area Intraparenchymal, <5cm diameterLaceration: 1-3cm parenchymal depth not involving a parenchymal vessel.

III Haematoma: Subcapsular, >50% surface area or expanding. Ruptured subcapsular or parenchymal haematoma. Intraparencymal haematoma >5cmLaceration: >3cm parenchymal depth or involving trabecular vessels

IV Laceration: Laceration of segmental or hilar vessels producing major devascularization (>25% of spleen)

V Laceration: Completely shattered spleenVascular: Hilar vascular injury which devascularized spleen

Grade V

Grade IV

Capsular tears of the spleen can be controlled

by compression only or by

using topical hemostatic agents.

Deeper lacerations can be controlled with horizontal absorbable

mattress sutures.

Major lacerations involving less than 50% of the splenic parenchyma and not extending into the

hilum can be treated by segmental or partial splenic resection.

Resection is indicated only if the patient is stable and no other major injuries are present.

More extensive injuries involving the hilum or the central portion of the

spleen…

• Splenectomy.