1. Universidad de Guadalajara
Centro Universitario Ciencias de la Salud
Spleen
Trauma
Giovanna Lazcano Sherman
Dr. Héctor Manuel Virgen Ayala
November 2011 Dr. Benjamín Robles Mariscal

2. Anatomy
Develops from
mesenchymal
cells in the dorsal
mesogastrium
during the fifth
week of gestation.

4. The
peritoneum
covering the
spleen, except in
the hilum.

5. 7cm
150 gr.
(80 -300 gr). 12 cm
3 – 4 cm

6. Ligaments
• Gastrosplenic • Splenophrenic
• Splenorenal • Splenocolic

7. Irrigation and venous drainage

8. Histology/Physiology

10. Splenic
Trauma/Injury

11. The spleen is the
intra-abdominal
organ most
frequently
injured in blunt
trauma.

12. Splenic injury…
History of a
blow, fall, or
sports-related
injury

13. Splenectomy
Was considered
the only
acceptable
surgical option for
splenic injuries.
Recently, nonoperative management
have been considered adequate
options in patients
postsplenectomy syndrome

14. Overwhelming postsplenectomy
infection (OPSI)
• Sudden onset of symptoms.
• Rapid and fulminating course (12 to 18 hours).
• Fever.
• Nausea.
• Vomiting.
• Headache.
• Altered mental status.
Mortality
Is complicated by shock,
50% to 80% electrolyte imbalance,
hypoglycemia, and
polyvalent pneumococcal disseminated intravascular
vaccine
coagulation.

15. The diagnosis is
confirmed by
ECO - CT
(hemodynamic
stability) or
exploratory
laparotomy
(hemodynamic
instability)

16. Nonopertative Treatment
• Hemodynamic stability.
70%
• Normal abdominal examination.
• Absence of contrast extravasation on CT.
• Absence of other clear indications for exploratory
laparotomy or associated injuries requiring surgical
intervention.
• Absence of associated health conditions that carry an
increased risk for bleeding (coagulopathy, hepatic
failure, use of anticoagulants, specific coagulation factor
deficiency)
• Injury grade I to III.

17. Surgical
treatment of a
splenic injury
depends on its
severit the presence
of shock, and
associated injuries.

18. Organ Injury Scaling-American Association
From Moore EE, Cogbill TH, Jurkovich GJ, et al: Organ injury scaling: Spleen and liver
of the Surgery of Trauma (OIS-AAST)
(1994 revision). J Trauma 38:323-324, 1995, with permission.
Grade Injury Description
I Haematoma: Subcapsular, <10% surface area
Laceration: Capsular tear, <1cm parenchymal depth
II Haematoma: Subcapsular, 10-50% surface area
Intraparenchymal, <5cm diameter
Laceration: 1-3cm parenchymal depth not involving a parenchymal
vessel.
III Haematoma: Subcapsular, >50% surface area or expanding.
Ruptured subcapsular or parenchymal haematoma.
Intraparencymal haematoma >5cm
Laceration: >3cm parenchymal depth or involving trabecular vessels
IV Laceration: Laceration of segmental or hilar vessels producing major
devascularization (>25% of spleen)
V Laceration: Completely shattered spleen
Vascular: Hilar vascular injury which devascularized spleen

19. Grade IV
Grade V

20. Capsular tears of the
spleen can be controlled
by compression only or by
using topical
hemostatic agents.

21. Deeper lacerations can be controlled
with horizontal absorbable
mattress sutures.

22. Major lacerations involving less than 50% of the
splenic parenchyma and not extending into the
hilum can be treated by segmental or
partial splenic resection.
Resection is indicated only if the patient is stable and no other
major injuries are present.

23. More extensive injuries involving the
hilum or the central portion of the
spleen…
•Splenectomy.