From the Guidelines
Management of a splenic laceration seen on CT abdomen/pelvis depends on the severity of the injury and the patient's hemodynamic stability, with non-operative management recommended for hemodynamically stable patients with low-grade lacerations (grades I-III) and surgical intervention, including splenectomy or splenic artery embolization, for hemodynamically unstable patients or those with high-grade injuries (grades IV-V). The decision between conservative management and surgery should be made by a trauma surgeon based on injury grade, hemodynamic status, presence of other injuries, and ongoing blood loss 1. Yes, splenic laceration can cause thrombocytopenia through two mechanisms: active bleeding from the laceration can consume platelets, and the damaged spleen may sequester platelets as part of its normal filtering function, which becomes dysregulated after injury 1. Following splenectomy, patients require vaccination against encapsulated organisms (pneumococcus, meningococcus, and Haemophilus influenzae type B) and lifelong antibiotic prophylaxis due to increased risk of overwhelming post-splenectomy infection.
Some key points to consider in the management of splenic laceration include:
- The use of CT scan with intravenous contrast as the gold standard in hemodynamically stable or stabilized trauma patients to define the anatomic spleen injury and identify associated injuries 1
- The role of non-operative management (NOM) in hemodynamically stable patients with low-grade lacerations, which is successful in 80-90% of cases 1
- The importance of close monitoring and repeated clinical and radiological assessment in patients undergoing NOM 1
- The potential use of therapeutic haemostatic angio-embolisation in patients with active bleeding or ongoing bleeding after splenic injury 1
It is essential to note that the management of splenic laceration should be individualized based on the patient's specific condition and the presence of other injuries. A multidisciplinary approach, including trauma surgeons, radiologists, and other healthcare professionals, is crucial in ensuring the best possible outcome for patients with splenic laceration.
From the Research
Management of Splenic Laceration
- The management of splenic laceration depends on the severity of the injury and the patient's hemodynamic stability 2.
- Nonoperative management (NOM) is often successful for hemodynamically stable patients with blunt splenic injuries, with a success rate of 80-95% 2, 3.
- Computed tomography (CT) scan with intravenous contrast is the preferred imaging modality for diagnosing and grading splenic injuries 4, 2, 5.
- Angioembolization is an important tool for splenic salvage and can be used to control active bleeding 2, 3.
- Patients with high-grade injuries (III-V) and those with intraparenchymal or subcapsular hematomas are at higher risk of failure of NOM and may require more aggressive management 3.
Relationship between Splenic Laceration and Thrombocytopenia
- There is no direct evidence in the provided studies to suggest that splenic laceration can cause thrombocytopenia.
- However, splenic injuries can lead to bleeding and hemodynamic instability, which may require transfusions and other interventions that could potentially affect platelet counts 2, 3, 5.
- Further research would be needed to determine if there is a direct relationship between splenic laceration and thrombocytopenia.
CT Scan Findings and Management
- CT scan findings, such as contrast extravasation or pseudoaneurysm, can be used to identify patients at risk of failure of NOM 3, 5.
- The American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) can be used to grade splenic injuries and guide management decisions 5.
- Multidetector computed tomography (MDCT) plays a crucial role in the diagnosis and management of splenic traumas, allowing for the detection and characterization of parenchymal and vascular traumatic lesions 5.