Splenic rupture

Question 1

What is the complication of splenic rupture?

Answer 1

• intraperitoneal haemorrhage
• haemorrhagic shock

Question 2

What causes pslenic rupture?

Answer 2

• abdominal trauma
  
  • seat-belt injuries
  • falls on left side
• EBV - splenomegaly

Question 3

What are the clinical features of splenic rupture?

Answer 3

• abdominal pain
• hypovolaemic shock
• LUQ tenderness
• Radiating left shoulder pain (Kehr’s sign) - due to blood irritating diaphragm

Question 4

What Ix would you perform for splenic rupture?

Answer 4

• Haemodynamically unstable + peritonism following trauma + abdominal bleeding: urgent laparotomy
• Haemodynamically stable: Urgent CT chest-abdo-pelvis c contrast

Question 5

What organ injury scale would you use for splenic rupture?

Answer 5

• American Associate for the Surgery of Trauma (AAST) splenic injury

Question 6

How would you Mx splenic rupture?

Answer 6

• Haemodynamically stable (grade 1-3)
  
  • conservative tx
  • resus
  • monitored
  • abdominal examinations
  • repeat scan after 1 week
  • prophylactic vaccinations
• Hamodynamically unstable (grade 5)
  
  • urgent laporotomy

Question 7

What type of patients benefit from embolisation of splenic injury and why is it advantageous?

Answer 7

• Pts with vascular abnormalities / high grade splenic injury
• dec. rate of laporotomy & splenectomy

Question 8

What are the complications of conservative tx and embolisation for splenic rupture?

Answer 8

• ongoing bleeding
• splenic necrosis
• splenic abcess/cyst
• thrombocytosis