Splenic Laceration

For this week's blog I decided to write about splenic lacerations because they fascinate me. It's so crazy to me that a laceration means removal of an organ! How is it possible that we have an organ that we can totally live without?

Injuries to the spleen are the most common abdominal injury after many forms of trauma including motor vehicle accidents, serious falls and sports injuries.

A lacerated spleen can present with many symptoms depending on the severity of the injury. The most common symptoms include right upper quadrant (RUQ) pain and rebound abdominal tenderness. A paler than normal complexion and low blood pressure can also be signs of a laceration to the spleen.

The most commonly used diagnostic exam for the diagnosis of a lacerated spleen is a CT of the abdomen with IV contrast. The use of IV contrast is very important to determine the severity of the injury.

I was surprised to find that there are actually multiple treatment options for a patient with a splenic laceration. I had always thought that removal of the spleen was the only option. But this is not the case. In fact, a splenectomy is often the last step in the treatment of this injury. One type of treatment is splenic angioembolization under fluoro, but not all hospitals have the facilities and staff necessary to perform this type of procedure. If this type of treatment is chosen, a surgeon and OR staff must be on standby if the injury is determined to be too severe for embolization. When surgery is deemed necessary, and exploratory laparotomy is performed to determine severity and helps the doctor decide whether the spleen can be repaired of if it needs to be removed. Follow up CT scans are necessary to determine if repair was successful and make sure there is no re-bleeding.

The most common problem associated with splenic lacerations is the increased chance of infection for the patient after treatment. Patients are encouraged to receive the pneumococcus vaccine after surgery and to take preventitive antiobiotics before any type of invasive surgery. These treatments of course are if a patient's spleen can be saved. If the spleen is removed, a patient must remain on medications such as steroids to promote platelet production and be continuously monitored for infection and blood loss. If these things are not monitored closely, a patient can suffer serious consequences, even death.

I found my image for this blog on ajronline.org and my information on emedicine.medscape.com