Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

Abstract

BackgroundSplenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution.Material/MethodsA retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients.ResultsA total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I–III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury.ConclusionsMost BSI patients had grade I–III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for appropriate management of BSI.

Analysis of the need for surgery for different anatomical locations of splenic injury and radiologic intervention

“…In this study, the risk of having to undergo embolization and/or surgery was higher when contrast blush was observed on CT. This finding is similar to those of previous reports (Davis et al ; Ochsner ; Haan et al ; Haan et al ; Bhullar et al ; Jabbour et al ). In this study, the risk of surgery or embolization was four times higher when contrast blush was observed.…”

Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes

“…Patients with blunt splenic trauma can present with left upper quadrant (LUQ) pain, abdominal distension, and/or hypotension. 15 They may exhibit referred pain to the left shoulder due to irritation of the phrenic nerve that innervates the ipsilateral diaphragm (i.e., Kehr's sign). 16 Abdominal wall or left lower chest wall tenderness, contusion, or instability are typical physical findings associated with splenic trauma.…”

Application of interventional embolization in the treatment of iatrogenic pseudoaneurysms

“…Pseudoaneurysm is usually caused by the disruption of arterial wall continuity. Such a disruption may be secondary to direct injury during an abdominal procedure or surgery or various endovascular treatments, or an indirect injury from post-operative peri-vascular inflammation or infections (18)(19)(20), resulting in the formation of pseudoaneurysm.…”