What is a splenic laceration?

What is a Splenic Laceration?

A splenic laceration is a tear in the spleen tissue that occurs most commonly from blunt abdominal trauma, representing the most frequently injured solid organ in abdominal trauma (accounting for approximately 42% of all abdominal injuries). 1

Definition and Mechanism

A splenic laceration specifically refers to a capsular tear or parenchymal disruption of the spleen tissue, ranging from superficial capsular tears less than 1 cm deep to complete shattering of the organ. 1 The injury occurs when traumatic force—typically from motor vehicle accidents (47.6%), falls (21.4%), or penetrating trauma (11.9%)—causes the splenic tissue to tear or rupture. 2, 3

Anatomic Classification

Splenic lacerations are graded by the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) based on depth and vascular involvement: 1

• Grade I: Capsular tear less than 1 cm parenchymal depth
• Grade II: Laceration 1-3 cm parenchymal depth not involving trabecular vessels
• Grade III: Laceration greater than 3 cm depth or involving trabecular vessels
• Grade IV: Laceration of segmental or hilar vessels producing major devascularization (>25% of spleen)
• Grade V: Completely shattered spleen or hilar vascular injury causing complete devascularization

Clinical Significance

The spleen is the most vulnerable visceral organ in blunt abdominal trauma, making splenic lacerations a critical injury requiring rapid assessment. 4, 3 The injury can result in:

• Intraperitoneal hemorrhage from active bleeding at the laceration site
• Subcapsular or parenchymal hematomas that may expand or rupture
• Delayed rupture occurring within 48 hours or more commonly between 4-10 days after initial injury 5
• Vascular complications including pseudoaneurysms or arteriovenous fistulas

Diagnostic Approach

CT scan with intravenous contrast is the gold standard for diagnosis, showing lacerations as linear or stellate areas of low attenuation within the splenic parenchyma with 90-95% sensitivity and specificity. 5, 3 The imaging reveals the depth of parenchymal disruption, presence of active extravasation (contrast blush), and associated hematomas.

Management Implications

The severity of the laceration directly correlates with management decisions and outcomes: 1

• 40-70% of patients with splenic lacerations can be managed non-operatively if hemodynamically stable
• Higher grade lacerations (III-V) have increased risk of hollow viscus injury (1.9% for minor vs. 11.6% for massive injuries) 1
• Associated injuries occur in 20-30% of cases, requiring comprehensive trauma evaluation 1

Common Pitfalls

• Hemodynamic stability does not exclude significant laceration: Even high-grade lacerations (IV-V) can present in stable patients who may be candidates for non-operative management with angioembolization. 1, 6
• Delayed presentation: Splenic lacerations can initially tamponade, then rupture days later, requiring vigilant monitoring during the healing period of 12.5 days for minor injuries and 37.2 days for severe injuries. 5
• Underestimating severity: The presence of a laceration on imaging mandates assessment for active bleeding, vascular injury, and volume of hemoperitoneum to guide treatment intensity. 3, 7