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Management of splenic injury in the adult trauma patient

INTRODUCTION

The spleen is one of the most commonly injured intra-abdominal organs. The diagnosis and prompt management of potentially life-threatening hemorrhage is the primary goal. The preservation of functional splenic tissue is secondary and in selected patients may be accomplished using nonoperative management or operative salvage techniques. Any attempt to salvage the spleen is abandoned in the face of ongoing hemorrhage or other life-threatening injuries. Emergent and urgent splenectomy remains a life-saving measure for many patients.

This topic will discuss the diagnosis and management of splenic injury. The management of spontaneous splenic rupture related to infectious or hematologic diseases as opposed to injury is discussed separately. (See "Approach to the adult patient with splenomegaly and other splenic disorders", section on 'Splenic rupture'.)

SPLENIC ANATOMY AND PHYSIOLOGY

The spleen is located posterolaterally in the left upper quadrant of the abdomen beneath the left hemidiaphragm and lateral to the greater curvature of the stomach. The gross anatomy of the spleen is described elsewhere. (See "Surgical management of splenic injury in the adult trauma patient", section on 'Anatomy of the spleen'.)

The spleen is a major lymphopoietic organ, comprising approximately 25 percent of the total lymphoid mass of the body. Normal splenic function is important for opsonization of encapsulated organisms. Splenic physiology is discussed in detail elsewhere. (See "Approach to the adult patient with splenomegaly and other splenic disorders", section on 'Normal splenic function'.)

MECHANISM OF INJURY

Splenic injury most commonly occurs following blunt trauma due to motor vehicle collisions (driver, passenger, or pedestrian). However, blunt splenic injury can also result from falls, sport-related activities, or assault [1]. Penetrating splenic trauma is less common than blunt injury and is typically due to assault, but inadvertent impalement may also occur. Assault with a knife compared with gunshot or shotgun wounds is less likely to result in penetrating injury due to the spleen's protected location.

                      

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Literature review current through: Oct 2014. | This topic last updated: Jul 29, 2014.
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