Splenic Rupture

Question 1

What is the most common cause of splenic rupture

Answer 1

Trauma

Question 2

Where does the blood pool after splenic rupture

Answer 2

Intra-peritoneal

Question 3

What are the clinical features of splenic rupture

Answer 3

LUQ pain
Signs of hypovolaemic shock
Kehrs sign as blood may irritate diaphragm

Question 4

What are the signs of haemodynamic instability

Answer 4

1. Cold hands, arms, legs, or feet, or a bluish discoloration of these areas (peripheral cyanosis)
2. Confusion.
3. Decreased urine output.
4. Low blood pressure (hypotension)

Question 5

What investigations would you carry out for a haemodynamically unstable patient that you suspect has had a splenic rupture

Answer 5

Immediate laparotomy must be carried out to partially/completely resect the spleen

Question 6

What investigations would you carry out for a haemodynamically stable patient

Answer 6

CT chest-abdo-pelvis

Question 7

Why is it useful to carry out a CT scan of a stable patient you suspect has a spleen rupture

Answer 7

CT scan allows you to grade the splenic injury and help you to decide who needs surgical treatment and who needs conservative treatment

Question 8

What is the AAST splenic injury scale

Answer 8

Grade 1 - sub-capsular haematoma less than 10% of SA
Grade 2 - sub-capsular haematoma 10 - 50% of SA
Grade 3 - sub-capsular haematoma more than 50% of SA
Grade 4 - any injury in the presence of a splenic vascular injury or active bleeding confined within splenic capsule
Grade 5 - shattered spleen/ bleeding into the peritoneum

Question 9

How do you treat unstable/grade 4-5 patients

Answer 9

Laparotomy with splenectomy
Vaccinations against NHS
Low dose Pen V prophylaxis

Question 10

How do you treat grades 1-3

Answer 10

Conservative treatment:

• > IV fluids
• > HDU with regular abdomen observations
• > bed rest
• > CT scan 1wk post surgery
• > if increasing tenderness there should be a low threshold for a re-scan and laparotomy
• > vaccinations against NHS

Question 11

What is embolisation of bleeding point

Answer 11

Minimally invasive procedure that can embolise the bleeding from the spleen if it has not shattered.

Question 12

What are the complications of treatment

Answer 12

Ongoing bleeding
Splenic necrosis
Splenic abscess
Thrombocytosis - ( increases coagulation therefore give aspirin )
OPSI - protect against encapsulated bacteria + low dose pen V