spleen trauma
DESCRIPTION
TRANSCRIPT
Universidad de Guadalajara
November 2011
Spleen Trauma
Centro Universitario Ciencias de la Salud
Giovanna Lazcano Sherman
Dr. Héctor Manuel Virgen Ayala
Dr. Benjamín Robles Mariscal
Anatomy
Develops from mesenchymal
cells in the dorsal mesogastrium during the fifth
week of gestation.
The
peritoneum covering the
spleen, except in the hilum.
7cm
12 cm
3 – 4 cm
150 gr. (80 -300 gr).
Ligaments • Splenophrenic • Splenocolic
• Gastrosplenic• Splenorenal
Irrigation and venous drainage
Histology/Physiology
Splenic Trauma/Injury
The spleen is the intra-abdominal
organ most frequently
injured in blunt trauma.
History of a blow, fall, or
sports-related injury
Splenic injury…
Splenectomy
Was considered the only
acceptable surgical option for splenic injuries.
Recently, nonoperative management have been considered adequate
options in patients
postsplenectomy syndrome
Overwhelming postsplenectomy infection (OPSI)
• Sudden onset of symptoms.• Rapid and fulminating course (12 to 18 hours).• Fever.• Nausea.• Vomiting.• Headache.• Altered mental status.
Is complicated by shock, electrolyte imbalance,
hypoglycemia, and disseminated intravascular
coagulation.
Mortality 50% to 80%
polyvalent pneumococcal vaccine
The diagnosis is confirmed by
ECO - CT (hemodynamic
stability) or exploratory laparotomy
(hemodynamic instability)
70%Nonopertative Treatment
• Hemodynamic stability. • Normal abdominal examination.• Absence of contrast extravasation on CT. • Absence of other clear indications for exploratory
laparotomy or associated injuries requiring surgical intervention.
• Absence of associated health conditions that carry an increased risk for bleeding (coagulopathy, hepatic failure, use of anticoagulants, specific coagulation factor deficiency)
• Injury grade I to III.
Surgical treatment of a
splenic injury depends on its
severit the presence of shock, and
associated injuries.
Organ Injury Scaling-American Association of the Surgery of Trauma (OIS-AAST)
From
Moo
re E
E, C
ogbi
ll TH
, Jur
kovi
ch G
J, et
al:
Org
an in
jury
sca
ling:
Spl
een
and
liver
(1
994
revi
sion
). J T
raum
a 38
:323
-324
, 199
5, w
ith p
erm
issi
on.
Grade Injury Description
I Haematoma: Subcapsular, <10% surface areaLaceration: Capsular tear, <1cm parenchymal depth
II Haematoma: Subcapsular, 10-50% surface area Intraparenchymal, <5cm diameterLaceration: 1-3cm parenchymal depth not involving a parenchymal vessel.
III Haematoma: Subcapsular, >50% surface area or expanding. Ruptured subcapsular or parenchymal haematoma. Intraparencymal haematoma >5cmLaceration: >3cm parenchymal depth or involving trabecular vessels
IV Laceration: Laceration of segmental or hilar vessels producing major devascularization (>25% of spleen)
V Laceration: Completely shattered spleenVascular: Hilar vascular injury which devascularized spleen
Grade V
Grade IV
Capsular tears of the spleen can be controlled
by compression only or by
using topical hemostatic agents.
Deeper lacerations can be controlled with horizontal absorbable
mattress sutures.
Major lacerations involving less than 50% of the splenic parenchyma and not extending into the
hilum can be treated by segmental or partial splenic resection.
Resection is indicated only if the patient is stable and no other major injuries are present.
More extensive injuries involving the hilum or the central portion of the
spleen…
• Splenectomy.