Splenic Rupture
Give some complications of conservative treatment or embolisation: (4)
1. Ongoing bleeding 2. Splenic necrosis 3. Splenic abscess or cyst 4. Thrombocytosis
How is diagnosis of spleen rupture usually made?
From investigations of abdominal pain following a history of trauma
What patients can be treated conservatively?
Haemodynamically stable patients with grade 1 to 3 injuries without active extravasation Should be on strict bed rest and have a repeat CT scan at 1 week post injury
What symptoms may a person with spleen rupture complain of?
May complain of abdominal pain but a proportion will only present with clinical features of hypovolaemic shock
Give some examples of common situations in which the spleen is injured?
Seat belt injuries in road traffic collisions
What are the majority of cases of splenic injury?
Secondary to abdominal trauma - particularly blunt trauma
What is the pathophysiology of overwhelming post-splenectomy infection?
The spleen is an immunologically active organ, with an active role in destroying encapsulated organisms, such as Pneumococcus, Meningococcus, and H. Influenzae. Asplenic patients are therefore unable to mount a normal immunological response against these organisms and infection can lead to overwhelming sepsis
How would a patient appear on examination?
They may have left upper quadrant tenderness and/ or peritonism - often becoming generalised as the blood loss increases
What should all asplenic patients be given?
Vaccinations against the three organisms mentioned in the previous card and potentially prophylactic penicillin V
What does the AAST splenic injury scale assess for?
Whether patients are likely to benefit from conservative management and which need surgery
What is the most commonly used scale for splenic injury?
The american association for the surgery of trauma AAST splenic injury scale
What do patients who are haemodynamically unstable with peritonism following trauma require?
These patients have abdominal bleeding until proven otherwise and will need immediate laparotomy
Why can splenic rupture cause left shoulder tip pain?
Free blood can irritate the diaphragm and cause a radiating left shoulder pain
What is the major risk with splenic rupture?
Intraperitoneal haemorrhage - large because the spleen is a heavily vascularised organ
What patients need an urgent laparotomy?
Patients who are haemodynamically unstable or with a grade 5 injury (shattered spleen or major hilar vascular injury)
What will patients need who are haemodynamically unstable with suspected abdominal injury?
Urgent CT CAP with IV contrast
