Splenic trauma
Background
- Blunt trauma injuries to the abdomen most commonly effect the liver and spleen
- Injuries to the spleen commonly result from RTC, violence, sports collisions and accidents involving bicycle handlebars.
CT Grading of Splenic Injury
The RCEM quote a 4 point grading system for splenic injury as shown below.
| Grade | Description |
|---|---|
| Grade 1 | Minor subcapsular tear or haematoma |
| Grade 2 | Parenchymal injury not extending to the hilum |
| Grade 3 | Major parenchymal injury involving vessels and hilum |
| Grade 4 | Shattered spleen |
Traditional grading system
| Grade | Description |
|---|---|
| I | Capsular tear < 1 cm parenchymal depth |
| II | Capsular tear 1-3 cm depth which does not involve a trebecular vessel |
| III | Laceration > 3 cm parenchymal depth involving trebecular vessels Ruptured subcapsular or parenchymal hematoma; intraparenchymal hematoma > 5 cm or expanding |
| IV | Laceration involving segmental or hilar vessels producing major devascularization (> 25% of spleen) |
| V | Shattered spleen or hilar vascular injury which devascularizes spleen |
Management
- Conservative in 80% of cases
- Angiography and embolisation or surgery (splenectomy) are usually reserved for those with uncontrolled bleeding and/or high grade injuries