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Splenic trauma

Key sources
The following summarized guidelines for the evaluation and management of splenic trauma are prepared by our editorial team based on guidelines from the Society of Interventional Radiology (SIR 2020), the World Society of Emergency Surgery (WSES 2017), and the Eastern Association for the Surgery of Trauma (EAST 2012).
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Guidelines

1.Diagnostic investigations

Diagnostic imaging: as per WSES 2017 guidelines, decide on diagnostic technique at admission based on the hemodynamic status of the patient.
A
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2.Medical management

Nonoperative management: as per WSES 2017 guidelines, attempt nonoperative management initially, irrespective of injury grade, in patients with hemodynamic stability and absence of other abdominal organ injuries requiring surgery.
B
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  • Thromboprophylaxis

3.Inpatient care

Serial clinical and laboratory assessment: obtain clinical and laboratory observation associated to bed rest in the first 48-72 hours of follow-up in patients with moderate and severe lesions.
B

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  • Serial imaging assessment

4.Therapeutic procedures

Angioembolization
As per SIR 2020 guidelines:
Consider performing splenic artery embolization in hemodynamically stable patients with grade IV/V blunt splenic trauma.
C
Consider performing embolization in hemodynamically stable patients with any grade injury with imaging or clinical evidence of ongoing splenic hemorrhage.
B

5.Surgical interventions

Indications for surgery: as per WSES 2017 guidelines, perform operative management in patients with hemodynamic instability and/or with associated lesions such as peritonitis or bowel evisceration or impalement requiring surgical exploration.
B
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6.Specific circumstances

Pediatric patients, evaluation: insufficient evidence regarding the role of eFAST in the diagnosis of pediatric spleen injury.
I
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  • Pediatric patients (nonoperative management)

  • Pediatric patients (angioembolization)

  • Pediatric patients (surgery)

  • Pediatric patients (follow-up)

7.Preventative measures

Immunizations: provide immunization against the encapsulated bacteria (S. pneumoniae, H. influenzae, and N. meningitidis) in asplenic/hyposplenic patients.
A
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  • Antimicrobial prophylaxis

8.Follow-up and surveillance

Follow-up
Consider obtaining follow-up CT after discharge in the presence of underlying splenic pathology or coagulopathy and in neurologically impaired patients.
C
Consider restricting activity for 4-6 weeks in patients with minor injuries and up to 2-4 months in patients with moderate and severe injuries.
C