Injured Spleen

Question 1

Most Common Solid Organ Injury after Blunt Trauma

Answer 1

Spleen

Question 2

Asplenism Increase Risk For

Answer 2

nonencapsulated organisms
myocardial infarctions
deep vein thrombosis
strokes
pulmonary hypertension
malignancy.

Question 3

Safe Candidates for Non Operative Management

Answer 3

-hemodynamic stability
-CT documentation and classification of the injury
-absence on CT scan of intraabdominal or retroperitoneal injuries mandating operative intervention
-transfusion of fewer than 2 units of PRBCs in a 24-hours

Question 4

Other Exclusion Criteria for NOM

Answer 4

-Portal hypertension (Relative Contraindication)
-coagulopathy cannot be reversed
-Those who must urgently receive anticoagulation therapy

Question 5

NOM

Answer 5

-Monitor Vitals
-Serial Abd Exam
-Serial Hb (6 Hrly for 48 Hrs)
-Angiography
-Early Enteral Feeding (Within 24-48 hrs)
-Repeat Ct (in 48 - 72 hrs)
-Bed Rest (for 24 hrs grade II-V)
-DVT Prophylaxis (Within 48 hrs ?)

Question 6

Types of Angioembolization

Answer 6

-By metal Coils or Gel Foams
-Proximal Embolization or Distal
-Vaccination After Embolization

-Proximal embolization in settings where a localized lesion is not identified
It is faster to perform , associated with fewer complications.
A disadvantage is the inability to reintervene

-Distal embolization when a lesion is localized (more targeted therapy)
It carries a higher risk of complications including splenic infarct and abscess
has a higher hemorrhage control success

Question 7

Splenic Repair Adjunct

Answer 7

Argon beam coagulation ( Radiofrequency Energy )
Fibrin glue Aka Tisseal ( Fibrinogen,thrombin,and CaCL)
Polyglycolic mesh wrap ( With Methylcellulose )

Question 8

When to consider Splenectomy over Repair

Answer 8

Unstable Patient
damage Control
Other Injuries ( Needs Further Workups or interventions )

Question 9

When to consider Partial Splenectomy

Answer 9

when early ligation of a branch of the splenic artery to a segment of the spleen results in major progress toward hemostasis
Provided that 50% of the splenic parenchyma attached to an identifiable vessel is viable

Question 10

Vaccinations

Answer 10

2 Weeks Post Op :

pneumococcal vaccine Prevnar 13
Haemophilus influenza type B
meningococcal vaccines

The pneumococcal vaccine followed by Pneumovax 23 at least 8 weeks after the initial vaccination.

Subsequent boosters for pneumococcal and meningococcal administered in 5 years.

Seasonal flu vaccines should be provided