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![SPLENIC RUPTURE
Splenic rupture can occur as trauma to normal spleen or
diseased spleen
Atraumatic rupture of a diseased spleen [pathologic rupture]
and spontaneous rupture of normal spleen [spontaneous
idiopathic rupture]
Spleen is the most common solid organ injured in blunt injury
abdomen
Classically associated with left lower ribs fracture
Delayed rupture is a characteristic feature in Subcapsular
hematoma
A ruptured spleen can cause life-threatening bleeding into the
abdominal cavity.](https://image.slidesharecdn.com/splenictrauma110907-250131033452-f60f2dfa/85/splenic-trauma-grading-and-it-s-management-2-320.jpg)
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Similar to splenic trauma , grading and it's management
splenic trauma , grading and it's management
- 1. BLUNT ABDOMINAL TRAUMA SPLENIC TRAUMA PRESENTEDBY:DR.SAUMYA CHIEF:DR.SURESH BABU M.S. HOD:DR.BANUREKHA M.S.,DGO
- 2. SPLENIC RUPTURE Splenicrupture can occur as trauma to normal spleen or diseased spleen Atraumatic rupture of a diseased spleen [pathologic rupture] and spontaneous rupture of normal spleen [spontaneous idiopathic rupture] Spleen is the most common solid organ injured in blunt injury abdomen Classically associated with left lower ribs fracture Delayed rupture is a characteristic feature in Subcapsular hematoma A ruptured spleen can cause life-threatening bleeding into the abdominal cavity.
- 3. H/O Bluntabdominal or lower thoracic trauma Penetrating trauma to Left Hypochondrium Iatrogenic Spontaneous rupture - Malaria - Leukemia - Infectious mononucleosis ETIOLOGY • Injury types • Laceration • Hilar injury • Subcapsular hematoma • Injury associated with other organ injuries • Mechanism of injury • Crushing • Deceleration • Sudden increase in intra abdominal pressure
- 4. SPLENIC RUPTURE H/OTrauma Pain abdomen Occasional distension and vomiting In severe bleeding associated with shock, syncope or dizziness Kher’s sign Pain over left shoulder joint Fixed dullness to percussion on the left, and shifting dullness on the right (Ballance’s sign). Tenderness all over the abdomen with or without guarding and rigidity CLINICAL FEATURES
- 5. SPLENIC RUPTURE Othercauses for hemoperitoneum Liver injury Ruptured ectopic pregnancy Ruptured abdominal aortic aneurysm Acute hemorrhagic pancreatitis DIFFERENTIAL DIAGNOSIS
- 6. Investigations (Imaging Modalities) • Focused Assessment with Sonography for Trauma (FAST): - Rapid, bedside detection of free fluid • CT Scan (gold standard): - Provides detailed grading of injury • Diagnostic peritoneal lavage (rarely used now) • Hemodynamic monitoring: Assesses severity
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- 8. INVESTIGATIONS- CECT CTis the procedure of choice for diagnosis and estimation of the degree of splenic injury in the hemodynamically normal patient. Contrast blush (intraparenchymal hyperdense contrast collection)suggests active hemorrhage and is associated with failure of nonoperative management in all solid organ injuries.
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- 10. AAST – CTGRADING
- 11. Classification of SplenicInjuries • Based on AAST (American Association for the Surgery of Trauma): - Grade I: Subcapsular hematoma <10% or capsular tear <1 cm - Grade II: Hematoma 10-50% or laceration 1-3 cm depth - Grade III: Hematoma >50% or laceration >3 cm - Grade IV: Laceration involving segmental vessels or devascularization - Grade V: Completely shattered spleen or hilar vascular injury
- 12. Management Approaches •Non-operative management (NOM): - Indicated in hemodynamically stable patients - Includes close monitoring, blood transfusions - Role of angioembolization in high-grade injuries • Surgical intervention: - Splenectomy: Preferred in unstable or severe injuries - Splenorrhaphy: Organ-preserving techniques
- 13. TREATMENT Nonoperative management RequiresICU monitoring in a dedicated trauma center and immediate ability to convert to operative management should that become necessary Indications Hemodynamic stability Minimal evidence of blood loss, < 2 units packed red blood cells as transfusion requirement Absence of active contrast extravasation on CT scan Absence of other indication for laparotomy Length of intensive care unit (ICU) monitoring is generally 24 to 48 hours initially, with serial hematocrit evaluation and continuous hemodynamic monitoring Blood transfusion is limited to 2 units of packed red blood cells. If the patient has an ongoing transfusion requirement of more than 2 units, operative management should be performed The majority of pediatric splenic trauma is successfully managed nonoperatively. Recovery recommendations include restricted activity in terms of contact sports, running, or similar stresses for 3 months following injury. Angiography is performed in patients who are hemodynamically normal and have a blush on initial CT scan.
- 14. Indications for Surgery • Hemodynamic unstability despite resuscitation • Failure of non-operative management (NOM) • High-grade injuries (Grade IV/V) with vascular involvement • Associated injuries requiring laparotomy • Splenic rupture with free intraperitoneal hemorrhage
- 15. TREATMENT Operative management Shouldbe performed in those patients demonstrating peritonitis or hemodynamic instability, those failing nonoperative therapy, and those with gunshot wounds to the abdomen Splenectomy is indicated with significant blood loss (>1000 mL), significant associated injuries, hilar involvement, coagulopathy, or massive splenic disruption Splenic salvage includes splenorrhaphy and partial splenectomy Splenorrhaphy can be performed with absorbable mesh (Dexon) Other strategies include the use of topical hemostatic agents, including Surgicel, Avitene, and topical thrombin, as well as the application of mattress sutures to allow tamponade of hemorrhage. Partial splenectomy may be performed for polar injuries. At least 30% of the spleen must be preserved to maintain function.
- 17. Splenectomy (Complete Removalof the Spleen) • Indications: - Uncontrollable bleeding - Completely shattered spleen or hilar vascular injury • Procedure: - Midline laparotomy incision - Ligation of splenic artery and vein - Mobilize spleen by dividing ligaments - Remove spleen and ensure hemostasis • Advantages: Definitive management of hemorrhage • Disadvantages: Risk of post-splenectomy infection (OPSI)
- 18. COMPLICATIONS Atelectasis whichshould be treated with aggressive pulmonary toileting Delayed bleeding in subcapsular hematoma Subpherenic abscess Pancreatic injury resulting Pancreatic fistula Thrombocytosis if platelets are > 10,00,000 OPSI- Overwhelming Post Splenectomy Infection
- 19. Post-Splenectomy Care •Vaccinations: - Pneumococcal, meningococcal, Haemophilus influenzae type b (Hib) • Antibiotic prophylaxis: - For invasive infections, especially in children • Patient education: - Importance of medical attention for febrile illnesses - Risk of overwhelming infections
- 20. OPSI Syndrome consistsof rapid development of severe sepsis with hypotension, disseminated intravascular coagulation, respiratory distress, and coma within hours of presentation Incidence. This is a rare complication of splenectomy. 50% to 70% of OPSI occurs less than 2 years after splenectomy. Mortaltiy is 50% to 70% for patients presenting with full-blown OPSI Organisms. S. pneumoniae is responsible for 50% to 90% of infections. Others include N. meningitides, H. influenzae Treatment. Aggressive empiric antibiotic therapy should be initiated awaiting pan-culture/sensitivities. Prophylaxis. Presplenectomy immunization (2 weeks before splenectomy) is optimal but most often impossible for traumatic splenectomy. Immunization for Pneumococcus, Meningococcus, and H. influenzae type B should be administered prior to discharge Pneumovax. Pneumococcal booster should be considered every 5 to 6 years for high-risk patients.
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