Blunt splenic trauma

Blunt Splenic Trauma

Blunt splenic trauma is a type of injury to the spleen that occurs without an open wound, typically resulting from a direct impact or force to the abdomen. It is a common injury in cases of motor vehicle accidents, falls, and sports-related incidents.

Anatomy of the Spleen

The spleen is an organ located in the upper left quadrant of the abdomen, beneath the diaphragm and adjacent to the stomach. It plays a crucial role in the immune system by filtering blood, recycling old red blood cells, and storing white blood cells and platelets.

Causes

Blunt splenic trauma is most often caused by:

• Motor vehicle collisions
• Falls from a significant height
• Direct blows to the abdomen during contact sports
• Assaults or physical altercations

Pathophysiology

When the spleen is subjected to a blunt force, it can result in:

• Contusion: Bruising of the splenic tissue
• Laceration: Tears in the splenic capsule or parenchyma
• Hematoma: Collection of blood within or around the spleen
• Rupture: Complete tearing of the splenic tissue, leading to internal bleeding

Clinical Presentation

Patients with blunt splenic trauma may present with:

• Abdominal pain or tenderness, particularly in the left upper quadrant
• Referred pain to the left shoulder, known as Kehr's sign
• Signs of hypovolemic shock such as tachycardia, hypotension, and pallor
• Guarding or rebound tenderness on physical examination

Diagnosis

The diagnosis of blunt splenic trauma is typically made using:

• Physical examination
• Ultrasound, particularly the Focused Assessment with Sonography for Trauma (FAST) exam
• Computed tomography (CT) scan of the abdomen and pelvis

Management

The management of blunt splenic trauma depends on the severity of the injury and the patient's hemodynamic stability:

Non-Operative Management

• Observation and monitoring in a hospital setting
• Serial hemoglobin and hematocrit measurements
• Bed rest and activity restriction

Surgical Intervention

• Splenectomy: Removal of the spleen, indicated in cases of severe injury or hemodynamic instability
• Splenorrhaphy: Repair of the spleen, an option in select cases to preserve splenic function

Complications

Potential complications of blunt splenic trauma include:

• Delayed splenic rupture
• Infection due to loss of splenic function
• Post-splenectomy sepsis

Prognosis

The prognosis for patients with blunt splenic trauma varies based on the severity of the injury and the timeliness of treatment. With appropriate management, many patients recover fully.

Prevention

Preventive measures include:

• Use of seat belts and airbags in vehicles
• Protective gear in contact sports
• Safety measures to prevent falls

See Also

• Abdominal trauma
• Splenic injury
• Trauma surgery

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