Fact-sheet: Spleen trauma - fracture
Updated on 09/17/2021 at 12:16 PM
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Definition
The spleen is classically the most frequently injured intra-abdominal organ
Clinical features
polytrauma context,
abdominal pain, or asymptomatic
Ultrasound
Ultrasound has poor performance for the detection of traumatic splenic injury,
even with the addition of ultrasound contrast agent
CT
Examination of choice.
Splenic lacerations: linear hypodense images, more or less branching, sometimes stellate.
Rupture: lacerations extending from one edge of the spleen to the other.
Hematomas: subcapsular or intraparenchymal, spontaneously hyperdense on the non-contrast sequence and hypodense after contrast injection.
Splenic infarction: defect in splenic enhancement due to a segmental vascular lesion of a branch of a splenic artery.
Lesions at risk of bleeding:
-intra- or extrasplenic contrast extravasation
-pseudoaneurysm
Vascular intervention
An increasing number of severe grade IV or V injuries are treated with interventional radiology
Management
The reference treatment for blunt splenic trauma depends on the patient's hemodynamic status:
– Hemostatic surgery (splenorrhaphy, splenectomy) if unstable
– Non-surgical:
Classification
American Association for Surgery of Trauma classification:
Grade I: Capsular tear, superficial fissure <1cm deep or subcapsular hematoma <1cm thick.
Grade II: Intraparenchymal laceration 1-3cm deep or subcapsular or intraparenchymal hematoma of 1-3cm.
Grade III: Parenchymal laceration >3cm or hematoma >3cm.
Grade IV: Major vascular injuries or splenic rupture into multiple fragments