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M M

• January 22, 2008
• Sunil S. Karhadkar, MD

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RC 15617969

• 46 / F belted driver T-boned, delayed
  extrication, air bags not deployed
• Primary survey A clear, unobstructed, B-
  clear, C- adequate
• Secondary survey GCS 15, AEBE, RRR, Neuro- NAD
• Vitals- HR 78 BP 105/55

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RC 15617969

• Physical exam
• Gen No acute distress, awake, alert
• Skin warm, well perfused
• HE ENT within normal limits
• RRR, CTA b/l
• Abd soft, non tender, non distended
• Suprapubic tenderness
• Rectal Normal tone, Guaiac neg

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RC 15617969
10.2
378
25
1613 hrs
31
140
105
17
121
3.5
25
0.7
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IR- Splenic artery embolization
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Operative record

• Splenectomy
• Coagulation of Liver lac
• EBL lt200 ml

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Post-op pleural effusion
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Morbidity

• Pleural effusion
• Proteus mirabilis UTI

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Splenic Injury Grading

• Laceration
• I lt 1cm deep
• II 1-3 cm deep
• III gt3cm deep
• trabecular v.
• IV segmental/hilar v
• V shattered spleen

• Hematoma
• I lt10 of area
• II 10-50 area
• III gt50 area

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Management of splenic trauma

• Peritoneal signs?
• Associated injuires?
• Shock?
• Age?

Non-operative Mx (adults)

• 50-80 of pts stable enough to get CT
• 3-15 of pts selected for conserv. Mx eventually
  need splenectomy

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Non-operative Mx (adults)

• ICU, very close observation
• Serial abdominal exams
• Serial Hgb/Hct
• Issue 1 delayed splenic rupture
• Issue 2 characteristics of pts that fail
  conserv Mx

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Splenic artery embolization

• 1 Selective v/s non selective.
• 2 Extravasation.
• 3 Cessation of extravasation.
• 4 Goal is NOT to produce infarction.