Flashcards in Splenic Salvage procedures, Trauma Deck (17):
What are the advantages of nonoperative management of splenic injuries?
Avoiding immunologic effects and the risks of laparotomy (intraabdominal injuries to pancreas), asplenia (risk of OPSI)
What is the prime determinant in operative versus nonoperative management in splenic injury?
What is a grade I splenic injury?
Hematoma with subscapular, <10% surface
What is a grade II splenic injury?
Subcapsular hematoma, 10-50% surface area, intraparenchymal hematoma, <5cm;
Laceration: Capsular tear from 1-3cm parenchymal depth
What is a grade III splenic injury?
Hematoma - subcapsular >50% surface area or expanding, ruptured or parenchymal hematoma; or intraparenchymal hematoma >5cm or expanding
Laceration >3cm parenchymal depth or involving trabecular vessels.
What is a grade IV splenic injury?
Laceration involving segmental or hilar vessels producing major (>25%) devascularization
What is a grade V splenic injury?
Completely shattered spleen, or hilar vascular injury with devascularized spleen
General indications for angioembolization for splenic injury
Controversial topic, but in general a contrast blush or pooling on CT, a higher grade injury (III +), persistent tachycardia and declining hematocrit are indications
Which criteria increase failure rate of angioembolizaion?
Presence of an arteriovenous fistula on CT scan, age >55, hemodynamic instability
Criterion for Nonoperative management of blunt splenic injury
Hemodynamic stability, absence of additional injuries requiring operative intervention, transfusion fewer than 2 units
At the time of initial injury, should chemical DVT prophylaxis be used in patients undergoing nonoperative treatment for blunt splenic injury?
No, chemical prophylactic anticoagulation is contraindicated.
What is the general consensus regarding resuming normal activities after blunt splenic trauma?
After 2-4 months
What is the most common cause of failure of nonoperative management?
Bleeding within 4 days on therapy
When is repeat imaging recommending for high grade injuries managed nonoperatively? (grades III-IV)
CT scan after 4-6 weeks
If a grade 1 or 2 splenic laceration is encountered during abdominal exploration for another indication, what is the preferred method of splenic repair?
Direct application of electrocautery or argon beam coagulator
If a grade 3 splenic laceration is encountered, and patient is stable, what are common options for splenorrhapy?
Manual compression, and pledgeted sutures to repair injury or mesh splenorrhapy over injured portions of the spleen.