The spleen is the most commonly injured organ involved in blunt trauma, and the diagnosis of splenic injury may be difficult. The clinical presentation includes left upper quadrant pain or referred pain to the left shoulder. Laboratory test results (e.g., hematocrit) do not always reflect the degree of splenic injury. However, because the spleen is the most vascular organ of the body, peritoneal bleeding from splenic injury can be potentially life-threatening. Ultrasonography (US) and Computed Tomography (CT) have a key role in the management of blunt splenic trauma. US is used first in hemodynamically stable patients with minor trauma, because how quick, noninvasive and easy it is to perform. US is also performed in unstable patient with the aim to detect the presence of hemoperitoneum.
CT is the gold standard for patient evaluation after blunt injury and for the detection and staging of splenic lesions. CT helps in differentiation of patients with active splenic bleeding (which could indicate a need for surgery) from patients with stable non-bleeding injuries, who are candidates for conservative management. Although splenectomy was considered the treatment of choice in the past, non-operative management of blunt splenic trauma is currently the standard of care in patients who are hemodynamically stable. Recently, to increase the number of patients managed non-operatively, splenic artery embolization has been adopted when there is CT evidence of active bleeding. Hemodynamically unstable patients or those with failed nonsurgical management require surgery.
KeywordsAbdominal trauma Spleen injury Computed tomography CEUS Management Splenic embolization Splenectomy
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