Splenic Injury



  • 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


  • 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
  • Iatrogenic injuries to the spleen can result from surgical or endoscopic manipulation of the stomach, pancreas, kidney, or proximal abdominal aorta
  • 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 second most common cause of death after head injury

There's more to see -- the rest of this topic is available only to subscribers.