From the Guidelines
The management of a splenic hematoma depends on the severity and stability of the patient, with conservative management recommended for hemodynamically stable patients with small to moderate hematomas, and surgical intervention necessary for unstable patients or those with large hematomas (>5 cm). The diagnosis of a splenic hematoma typically involves imaging studies such as CT scans or ultrasound, which can help determine the size and location of the hematoma, as well as the presence of any associated injuries. According to the World Society of Emergency Surgery (WSES) classification and guidelines for adult and pediatric patients 1, the management of splenic trauma should be multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Some key points to consider in the management of splenic hematoma include:
- Hemodynamically stable patients with small to moderate hematomas can be managed conservatively with hospital admission for observation, bed rest, pain control, and serial monitoring of vital signs and hemoglobin levels 1.
- Patients should avoid physical activity for 2-3 months to prevent rupture 1.
- Unstable patients or those with large hematomas (>5 cm) may require surgical intervention, ranging from splenorrhaphy (repair) to partial or total splenectomy 1.
- If splenectomy is performed, patients require vaccinations against encapsulated organisms (pneumococcal, meningococcal, and Haemophilus influenzae type B) and prophylactic antibiotics (typically penicillin V 250-500 mg twice daily) for at least 2 years 1.
- Follow-up imaging with ultrasound or CT scan is recommended at 1-2 weeks and then at 1-3 months to ensure resolution 1. It's also important to note that the management of pediatric patients with splenic trauma should be different from adults, and children should always be treated in dedicated pediatric trauma centers 1.
From the Research
Diagnosis of Splenic Hematoma
- Splenic hematoma is a known complication of blunt force abdominal trauma 2
- It can also occur spontaneously without any identifiable cause, posing a significant diagnostic challenge due to atypical findings 3
- Diagnostic imaging such as computed tomography (CT) scans can be used to diagnose splenic injuries, including hematomas 4
- Angiography can be used to further characterize the injury and predict the success of nonoperative management 4
Treatment of Splenic Hematoma
- Traditional management of splenic hematomas has been primarily surgical, but more recently, spleen-sparing management has been favored over surgical management for cases that meet certain criteria 2
- Nonoperative management, including bed rest and monitoring, can be effective for hemodynamically stable patients with splenic injuries of all grades and no other indications for laparotomy 4
- Coil embolization of the proximal splenic artery can be an effective method of hemostasis in stabilized patients with splenic injury 4, 5
- Splenectomy may be necessary in cases where nonoperative management is unsuccessful or in patients with recurrent bleeding 3, 5
- Splenic artery embolization can be used to stabilize patients with splenic hematoma, especially those with hemodynamic instability 3, 5