Blunt Splenic Trauma

Spleen injury should be recognized as quickly as possible to prevent the patient bleed to death. There are some criteria to define patients who can be managed nonoperatively. The first criterion is hemodynamic stability. The second important criterion is the presence of peritonitis. Patient with hemodynamic stability and without signs of peritonitis should undergo CT scan. Angiography should be considered if CT scan shows splenic injury greater than III, presence of contrast blush, aneurysm, or arteriovenous fistula, moderate hemoperitoneum, or another evidence of ongoing splenic bleeding. If none of these signs and no other severe injury present, nonoperative management can be done. The patient must be monitored for the first 48 hours and daily blood count should be considered on the first 4 days. Increasing or persistent abdominal pain, and unexplained drop in hemoglobin. If new instability shows up, patient should undergo exploratory laparotomy.