Abdominal wall injuries for undergraduates - Splenic injury

SPLENIC INJURY

Most common intra- abdominal organ to injured (40-55%)

20% of splenic injuries due to left lower rib fractures 

Commonly arterial hemorrhage

:Conservative management

              -Hemodynamic stability

             - Negative abdominal examination

             -Absence of contrast extravasation in CT

             - Absence of other indication of Laprotomy

           -Grade 1to 3 (Subcapsular Hematoma ,Laceration <3 cm)

Monitoring

Serial  Examinations & Haematocrit are essential 

Success rate of conservative m/m is >80%

Operative Management

Capsular tears (I)- Compression & topical haemostatic agent

Deep Laceration (II)-  Horizontal mattress suture

                             or Splenorrhaphy

Major Laceration not involving hilum (IV)-

                                  Partial Splenectomy

Hillar injury (V)–Total Splenectomy

Grade IV-V: almost invariably require operative intervention

Success rate of Splenic salvage procedure is 40-60%