What is the treatment for splenic damage?

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Treatment of Splenic Damage

The treatment of splenic damage should follow a hemodynamic-based algorithm, with non-operative management (NOM) being the preferred approach for hemodynamically stable patients, while immediate operative management is required for unstable patients with ongoing hemorrhage. 1

Initial Assessment and Management

Hemodynamically Unstable Patients

  • Immediate operative management (OM) is indicated for:
    • Patients with persistent hemodynamic instability despite resuscitation
    • Significant drop in hematocrit levels requiring continuous transfusions
    • Associated injuries requiring laparotomy
    • Severe splenic injuries (grade IV-V) in centers without intensive monitoring capabilities
    • Concomitant severe traumatic brain injury where hypotension must be avoided 1, 2

Hemodynamically Stable Patients

  • Non-operative management (NOM) is preferred when:
    • Patient is hemodynamically stable
    • No evidence of other injuries requiring laparotomy
    • Continuous monitoring is available
    • No significant drop in hematocrit 1, 3

Treatment Options

1. Non-Operative Management (NOM)

  • Indicated for hemodynamically stable patients
  • Requires:
    • Serial clinical examinations
    • Hemoglobin/hematocrit monitoring every 6 hours
    • Bed rest for 48-72 hours
    • Activity restriction for 2-4 months for moderate to severe lesions 2
  • Success rates have increased from 70% to 87% in pediatric patients 4

2. Splenic Artery Embolization (SAE)

  • Consider for:
    • Hemodynamically stable patients with signs of persistent hemorrhage
    • Presence of vascular abnormalities (pseudoaneurysm, active extravasation) on CT
    • Grade 5 injuries in stable patients 1, 2
  • Be aware of post-embolization syndrome (pain, nausea, ileus, fever) which typically resolves within 6-9 days 2

3. Operative Management

  • Splenectomy is indicated when:
    • NOM with SAE fails
    • Patient remains hemodynamically unstable
    • Significant drop in hematocrit or continuous transfusion requirements
    • Transfusion requirements exceed 40 mL/kg 1, 4
  • Splenorrhaphy (splenic repair):
    • Can be attempted during operation for selected injuries
    • Utilizes hemostatic agents, capsular sutures, and arterial ligation 5, 6
    • Rate of splenectomy has decreased from 24% to 4% in pediatric patients 4

Post-Treatment Care

After Non-Operative Management

  • ICU admission with continuous monitoring for at least 24-48 hours
  • Serial hemoglobin/hematocrit checks
  • Repeat imaging for moderate to severe lesions or decreasing hematocrit 2

After Splenectomy

  • Vaccination against encapsulated bacteria:
    • S. pneumoniae, H. influenzae, N. meningitidis
    • Should start 14 days after splenectomy 1, 2
  • Antibiotic prophylaxis:
    • Lifelong prophylactic antibiotics, especially in first two years
    • Adults: Penicillin 250-500 mg 12 hourly (or erythromycin if allergic)
    • Children: Dose adjusted by age 1
  • Patient education:
    • Wear Medic-Alert disc
    • Carry information card about lack of spleen
    • Keep emergency antibiotics at home
    • Seek immediate medical help for febrile illness 1

Special Considerations

  • Animal bites: Require five-day course of co-amoxiclav (erythromycin if allergic) due to risk of C. canimorsus infection 1
  • Tick bites: Patients should be warned about risk of babesiosis 1
  • Travel: Special precautions needed; seek immediate medical help for febrile illness 1

Complications to Monitor

  • Overwhelming post-splenectomy infection (OPSI) occurs in about 0.6% of children and 0.3% of adults 5
  • Postoperative bleeding after splenectomy occurs in 1.6-3% of cases, with mortality rate of about 20% 1
  • Infectious complications are significantly higher in splenectomy (32%) compared to NOM (4.8%) 1

The treatment approach should be guided by the patient's hemodynamic status, grade of splenic injury, available resources, and presence of associated injuries. Early consultation with trauma specialists is essential for optimal outcomes.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Management of Splenic Pseudocysts

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Research

Management of splenic and pancreatic trauma.

Journal of visceral surgery, 2016

5
Research

Splenic trauma. Choice of management.

Annals of surgery, 1991

6
Research

Traumatic splenic injury: splenectomy vs. repair.

The American surgeon, 1979

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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