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Splenic Injury

Splenic Injury is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • The spleen is formed by reticular and lymphatic tissue and is the largest lymph organ.
  • The spleen lies posterolaterally in the left upper quadrant (LUQ) between the fundus of the stomach and the diaphragm.

Etiology

  • The spleen is the most commonly injured intra-abdominal organ:
    • In nearly 2/3 of cases, it is the only damaged intraperitoneal structure
    • Blunt mechanisms are more common
  • Motor vehicle accidents (auto–auto, pedestrian–auto) are the major cause (50–75%), followed by blows to the abdomen (15%) and falls (6–9%)
  • Mechanism of injury and kinematics are important factors in evaluating patients for possible splenic injury.
  • Splenic injuries are graded by type and severity of injury [American Association for the Surgery of Trauma (AAST) criteria]:
    • Grade I:
      • Hematoma: Subcapsular, <10% surface area
      • Laceration: Capsular tear, <1 cm in parenchymal depth
    • Grade II:
      • Hematoma: Subcapsular, 10–50% surface area; intraparenchymal, <5 cm in diameter
      • Laceration: Capsular tear, 1–3 cm in parenchymal depth and not involving a trabecular vessel
    • Grade III:
      • Hematoma: Subcapsular, >50% surface area or expanding, ruptured subcapsular or parenchymal hematoma; intraparenchymal hematoma, ≥5 cm or expanding
      • Laceration: >3 cm in parenchymal depth or involving the trabecular vessels
    • Grade IV:
      • Laceration: Involving the segmental or hilar vessels and producing major devascularization (>25% of spleen)
    • Grade V:
      • Laceration: Completely shattered spleen
      • Vascular: Hilar vascular injury that devascularizes the spleen

Pediatric Considerations
  • Poorly developed musculature and relatively smaller anteroposterior diameter increase the vulnerability of abdominal contents to compressive forces.
  • Rib cage is extremely compliant and less prone to fracture in children but provides only partial protection against splenic injury.
  • Splenic capsule in children is relatively thicker than that of an adult; parenchyma of spleen seems to contain more smooth muscle than in adults.
  • Significant abdominal injury occurs in only about 5% of child abuse cases but is the 2nd most common cause of death after head injury.

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Citation

Rosen, Peter, et al., editors. "Splenic Injury." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307027/all/Splenic_Injury.
Splenic Injury. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307027/all/Splenic_Injury. Accessed April 20, 2019.
Splenic Injury. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307027/all/Splenic_Injury
Splenic Injury [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 20]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307027/all/Splenic_Injury.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Splenic Injury ID - 307027 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307027/all/Splenic_Injury PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -