Splenic injuries and their management.pptx

The spleen, a vital intra-abdominal organ, is commonly injured in blunt trauma abdomen often leading to life-threatening bleeding.
As the body's most vascular organ, the spleen often sustains injuries resulting in significant bleeding and hemoperitoneum.
Understanding the nuances of splenic injuries is crucial, as overlooking them can lead to preventable traumatic deaths.
The management of splenic trauma necessitates an interprofessional healthcare team

1. Splenic injuries and their management

2. Introduction: The spleen, a vital intra-abdominal organ, is commonly injured in blunt trauma abdomen often leading to life-threatening bleeding. As the body's most vascular organ, the spleen often sustains injuries resulting in significant bleeding and hemoperitoneum . Understanding the nuances of splenic injuries is crucial, as overlooking them can lead to preventable traumatic deaths. The management of splenic trauma necessitates an interprofessional healthcare team.

3. Etiology: The primary cause- road traffic accidents Other causes include - Direct blunt trauma falls indirect trauma, such as a tear in the splenic capsule during colonoscopy or excessive traction on the splenocolic ligament during surgical procedures Penetrating injury

4. Patho physiology In patients with trauma, splenic disruption can occur with or without capsular injury. If the capsule remains intact, an intraparenchymal or subcapsular hematoma develops Laceration of the splenic capsule results in hemoperitoneum and a splenic hematoma.

5. When to suspect a intraabdominal injury???????

6. Signs of extra-abdominal injury-abrasions, lacerations, contusions, and seatbelt signs Hypotension Tenderness Rigidity Distension Other concomitant injuries like femur fractures While the absence of these signs and symptoms may reduce the probability of intra-abdominal injury, their nonexistence, whether alone or in combination, is insufficient to completely rule out the likelihood of injury Hence every trauma patient must be assessed for intraabdominal injuries

7. Symptoms and signs associated with splenic injury The presentation of splenic injury varies depending on the associated internal hemorrhage tenderness in the upper left quadrant, generalized peritonitis referred pain in the left shoulder (known as Kehr sign) pleuritic left-sided chest pain hypovolemic shock, characterized by tachycardia and hypotension Balance sign - dullness left HQ, shifting dullness RHQ.

8. Evaluation: eFAST CECT scan e FAST - a rapid diagnostic tool A positive FAST result is indicated by the presence of fluid and is observed as an anechoic band or a black rim around the spleen. CECT scan - Accurate Grading of splenic injuries is based on CECT .

9. Other tests Hematocrit - less than 30% - should increase suspicion of intraabdominal hemorrhage Faling Hb, postural hypotension Low CVP, oliguria, raised BUN

10. Organ Injury Scale The American Association for the Surgery of Trauma (AAST) splenic injury scale is the most commonly used system for grading splenic trauma. It is used to help guide which patients are likely to benefit from conservative management and which need surgery. Grade of Injury 1 – Capsular tear <1cm parenchymal depth – Subcapsular haematoma <10% surface area 2– Capsular tear 1-3cm parenchymal depth – Subcapsular 10-50% surface area, or intraparenchymal <5cm 3– Capsular tear >3cm parenchymal depth, or any tear involving trabecular vessels – Subcapsular >50% surface area, or intraparenchymal >5cm, or any expanding or ruptured haematoma . 4– Laceration involving segmental or hilar vessels, devascularising >25% of the spleen 5– Completely shattered spleen or hilar vascular injury, devascularising the entire spleen

11. Management Primary goal is to resuscitate the patient. 2 modalities nonoperative Observation Embolisation Operative Splenorraphy Splenectomy The primary goal of treating splenic injury is to maximize salvage therapy through nonoperative measures, thereby avoiding the necessity for splenectomy.

12. The common indications for splenectomy include: Hemodynamic instability: Hemodynamically unstable patients should be taken emergently to the operating room, which is considered an indication of emergent splenectomy. Peritonitis Pseudoaneurysm formation Associated intra-abdominal injuries that require surgical exploration, such as bowel injuries Failure of embolisation technique or signs of deterioration if the patient is kept for observation

13. Splenorraphy : Suture the wound Topical agents like thrombin, oxidised cellulose are placed on the wound . Nowadays Splenorraphy is not routinely performed due to embolisation in such patients

14. Splenectomy: Removal of spleen

15. Indications for embolisation: Grade III or higher splenic injury Contrast blush on CT scan Moderate hemoperitoneum Evidence of ongoing bleeding

16. Complications after splenic injuries include: Delayed splenic rupture, though rare, may manifest up to 10 days post-injury, often associated with subtle low-grade spleen injuries that may not have been detected in imaging studies. Readmission due to bleeding Splenic artery pseudoaneurysm Post-splenectomy infection risk is highest within the first 2 years after splenectomy, but it can occur at any time Splenic abscess Pancreatitis Death

17. Postoperative and Rehabilitation Care: Post-splenectomy patients should receive vaccinations against encapsulated bacteria within 14 days of splenectomy.