An injury to the spleen usually occurs as a result of blunt abdominal trauma. Patients often have abdominal pain, sometimes radiating to the shoulder and tenderness. The diagnosis is made by CT or ultrasound. The treatment consists of observation and sometimes surgical repair, splenectomy rarely necessary.
(See also abdominal injuries at a glance.)
An injury to the spleen usually occurs as a result of blunt abdominal trauma. Patients often have abdominal pain, sometimes radiating to the shoulder and tenderness. The diagnosis is made by CT or ultrasound. The treatment consists of observation and sometimes surgical repair, splenectomy rarely necessary. (See also abdominal injuries at a glance.) Etiology Considerable force (z. B. in a motor vehicle accident) can hurt the spleen, but also penetrating injuries (z. B. knife wounds, gunshot wound). Splenomegaly due to fulminant Epstein-Barr virus (infectious mononucleosis or by Epstein-Barr virus mediated pseudo lymphoma after transplantation) predisposed to rupture of the spleen with minimal trauma, or even for a spontaneous rupture of the spleen. Splenic range from subcapsular hematoma and injuries small capsule to deep parenchymal cuts, crushing injuries and demolition from the stalk. Splenic classification depending on the severity divided into 5 classes (degrees of severity of injury to the spleen). Severity of injury to the spleen injury degree 1 subcapsular hematoma <10% of the area of ??injury <1 cm deep 2 subcapsular hematoma 10-50% of the area, intraparenchymales hematoma <5 cm injury 1-3 cm deep and without involving a trabecular vessel 3 subcapsular hematoma > 50% of the area, intraparenchymales hematoma ? 5 cm, expanding or gerissenenes hematoma injury> 3 cm deep without the involvement of a trabecular en vessel 4 injury involving segmental or Hilusgefäßen which affects> 25% of the area of ??the spleen 5 Completely crushed spleen hilar vessel injury, which decimates the tissue of the spleen pathophysiology essential immediate result is a blood flow into the abdominal cavity inside. The extent of the bleeding enough to massively from low, depending on the type and severity of the injury. Many small injuries, especially in children, listen to spontaneous bleeding. Major injuries bleed extensively, often causing a hemorrhagic shock. A hematoma of the spleen may rupture, usually in the first few days, although a rupture can occur hours or even months after the injury. Symptoms and complaints signs such as severe bleeding, including hemorrhagic shock, abdominal pain and distention of the abdomen are usually clinically apparent. Reduced bleeding cause pain in the left upper quadrant, which can sometimes radiate to the left shoulder. Patients with unexplained pain in the left upper quadrant, especially if there are signs of hypovolemia or shock, should be asked about recently experienced trauma. Stay very attentive regarding the suspicion on spleen injury in patients who had left rib fractures. Tips and risks ask especially if hypovolemia or shock are present patients with unexplained abdominal pain in the left upper quadrant after the recent trauma (including contact sports). Diagnostic imaging methods (CT and ultrasonography) The diagnosis is confirmed in stable patients with CT and for unstable patients with ultrasonography or exploratory laparotomy at the bedside. Treatment observation Angioembolization Sometimes surgical repair or splenectomy In the past, the treatment for each violation of the spleen splenectomy. However, splenectomy should be avoided if possible, especially in children, the elderly and patients with hematologic malignancies, in order to avoid consequent permanent susceptibility to bacterial infections, which increases the risk of overwhelming sepsis after splenectomy. The most common pathogens are Streptococcus pneumoniae, but other encapsulated bacteria such as Neisseria sp. and Haemophilus sp. may also be included. At present, most low-grade and high-grade many Splenic Injuries can be treated conservatively, even in the elderly (d. E.> 55 years). Hemodynamically stable patients who have no other indications for laparotomy such. B. Hohlorganperforation be monitored for vital signs, abdominal examined and continuously checked for hematocrit. The need for transfusion is compatible with conservative treatment, especially if there are other associated injuries such. B. fractures of the long bones. However, it should be a predetermined threshold for transfusion give (usually 2 units for an isolated splenic injury). If it is violated, surgery should be done to prevent morbidity and mortality. In a high volume trauma center 75% failed by those who received a conservative treatment, within two days, 88% within five days, and 93% within seven days after the injury (1). Similar to liver injury, there is no consensus in the literature regarding the duration of limited activity, optimal length of stay in the ICU or in the hospital, the timing of the resumption of diet, or the need for repeat imaging for injuries of the spleen treated conservatively patients with significant ongoing bleeding, d. H. Patients receiving continuous transfusions or have a decreased hematocrit, need a laparotomy. Sometimes an angiogram is performed with selective embolization of bleeding vessels if the patients are hemodynamically stable. If surgery is required, a blood flow can sometimes be controlled by a partial splenectomy by sewing, topical hemostatic agent (eg., Oxidized cellulose, Thrombinverbindungen, fibrin glue) or. A splenectomy is sometimes but still required. Splenectomized patients should be vaccinated against pneumococcal, many doctors vaccinated against Neisseria and Haemophilus spp. Treatment Note Stassen NA, Bhullar I, Cheng JD. Nonoperative management of blunt hepatic injury: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73: S288-S293, 2012. Key points splenic injuries are common and can occur with minimal trauma when the spleen is enlarged. The main complications are immediate bleeding and delayed Hämatomruptur. Confirm the diagnosis with CT in stable patients with ultrasound and exploratory laparotomy in unstable patients. A permanently increased susceptibility of the patient to bacterial infection (caused by splenectomy) to prevent, treat, if possible, splenic injuries conservative. Perform laparotomy or angiography with embolization in patients who have a substantial ongoing need for transfusion and / or decline in Hct.