Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Surgical management of splenic injury in the adult trauma patient

Adrian A Maung, MD, FACS
Lewis J Kaplan, MD, FACS
Section Editor
Eileen M Bulger, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Surgical management is required in approximately 20 to 40 percent of patients sustaining splenic injury. Open surgical techniques are the current standard of care and are typically used to manage the injured spleen, though laparoscopic techniques have been described in case reports and small series.

This topic will discuss the indications and techniques of exploratory laparotomy in the setting of trauma, hemorrhage control from the spleen, splenic salvage and splenectomy.

Nonoperative management of splenic injury is discussed elsewhere. (See "Management of splenic injury in the adult trauma patient".)


We perform initial resuscitation, and diagnostic evaluation of the trauma patient is based upon the Advanced Trauma Life Support (ATLS) program established by the American College of Surgeons Committee on Trauma. Emergent abdominal surgical exploration is indicated for the hemodynamically unstable trauma patient who has a positive focused assessment with sonography in trauma (FAST exam) or diagnostic peritoneal aspiration/lavage (DPA/DPL) to control life-threatening hemorrhage, which may be due to an injured spleen. (See "Initial evaluation and management of blunt abdominal trauma in adults" and "Initial evaluation and management of abdominal gunshot wounds in adults" and "Initial evaluation and management of abdominal stab wounds in adults" and "Initial evaluation and management of blunt thoracic trauma in adults".)

The hemodynamically stable trauma patient with splenic injury identified on computerized tomography (CT scan) may be initially observed or undergo angiographic embolization as an adjunct to observational management. However, observational management requires adequate resources, and if unavailable, initial surgical management should be considered depending on the patient’s medical comorbidities. (See "Management of splenic injury in the adult trauma patient", section on 'Management approach'.)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jan 26, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.
  2. Tsuei BJ, Kearney PA. Hypothermia in the trauma patient. Injury 2004; 35:7.
  3. Root HD. Splenic injury: angiogram vs. operation. J Trauma 2007; 62:S27.
  4. Dent D. Splenic injury: angio vs. operation. J Trauma 2007; 62:S26.
  5. Franklin GA, Casós SR. Current advances in the surgical approach to abdominal trauma. Injury 2006; 37:1143.
  6. Casali M, Di Saverio S, Tugnoli G, et al. [Penetrating abdominal trauma: 20 years experience in a Western European Trauma Center]. Ann Ital Chir 2008; 79:399.
  7. Harbrecht BG, Zenati MS, Ochoa JB, et al. Evaluation of a 15-year experience with splenic injuries in a state trauma system. Surgery 2007; 141:229.
  8. Louredo AM, Alonso A, de Llano J JA, et al. [Usefulness of absorbable meshes in the management of splenic trauma]. Cir Esp 2005; 77:145.
  9. Achneck HE, Sileshi B, Jamiolkowski RM, et al. A comprehensive review of topical hemostatic agents: efficacy and recommendations for use. Ann Surg 2010; 251:217.
  10. Go PM, Goodman GR, Bruhn EW, Hunter JG. The argon beam coagulator provides rapid hemostasis of experimental hepatic and splenic hemorrhage in anticoagulated dogs. J Trauma 1991; 31:1294.
  11. Styrt B. Infection associated with asplenia: risks, mechanisms, and prevention. Am J Med 1990; 88:33N.
  12. Tsaroucha AK, Pitiakoudis MS, Chanos G, et al. U-stitching splenorraphy technique: experimental and clinical study. ANZ J Surg 2005; 75:208.
  13. Berry MF, Rosato EF, Williams NN. Dexon mesh splenorrhaphy for intraoperative splenic injuries. Am Surg 2003; 69:176.
  14. Fremont RD, Rice TW. Splenosis: a review. South Med J 2007; 100:589.
  15. Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet 2011; 378:86.
  16. Corazza GR, Tarozzi C, Vaira D, et al. Return of splenic function after splenectomy: how much tissue is needed? Br Med J (Clin Res Ed) 1984; 289:861.
  17. Connell NT, Brunner AM, Kerr CA, Schiffman FJ. Splenosis and sepsis: The born-again spleen provides poor protection. Virulence 2011; 2:4.
  18. Di Carlo I, Pulvirenti E, Toro A. A new technique for spleen autotransplantation. Surg Innov 2012; 19:156.
  19. Pisters PW, Pachter HL. Autologous splenic transplantation for splenic trauma. Ann Surg 1994; 219:225.
  20. Pucci E, Brody F, Zemon H, et al. Laparoscopic splenectomy for delayed splenic rupture after embolization. J Trauma 2007; 63:687.
  21. Kaban GK, Novitsky YW, Perugini RA, et al. Use of laparoscopy in evaluation and treatment of penetrating and blunt abdominal injuries. Surg Innov 2008; 15:26.
  22. Becker HP, Willms A, Schwab R. [Laparoscopy for abdominal trauma]. Chirurg 2006; 77:1007.
  23. Stein DM, Scalea TM. Nonoperative management of spleen and liver injuries. J Intensive Care Med 2006; 21:296.
  24. Ren CJ, Salky B, Reiner M. Hand-assisted laparoscopic splenectomy for ruptured spleen. Surg Endosc 2001; 15:324.
  25. Basso N, Silecchia G, Raparelli L, et al. Laparoscopic splenectomy for ruptured spleen: lessons learned from a case. J Laparoendosc Adv Surg Tech A 2003; 13:109.
  26. Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients. Surg Endosc 2006; 20:1423.
  27. Carobbi A, Romagnani F, Antonelli G, Bianchini M. Laparoscopic splenectomy for severe blunt trauma: initial experience of ten consecutive cases with a fast hemostatic technique. Surg Endosc 2010; 24:1325.
  28. Feliz A, Shultz B, McKenna C, Gaines BA. Diagnostic and therapeutic laparoscopy in pediatric abdominal trauma. J Pediatr Surg 2006; 41:72.
  29. Taner AS, Topgul K, Kucukel F, et al. Diagnostic laparoscopy decreases the rate of unnecessary laparotomies and reduces hospital costs in trauma patients. J Laparoendosc Adv Surg Tech A 2001; 11:207.
  30. Kawahara NT, Alster C, Fujimura I, et al. Standard examination system for laparoscopy in penetrating abdominal trauma. J Trauma 2009; 67:589.
  31. Sauerland S, Agresta F, Bergamaschi R, et al. Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 2006; 20:14.
  32. Ayiomamitis GD, Alkari B, Owera A, Ammori BJ. Emergency laparoscopic splenectomy for splenic trauma in a Jehovah's Witness patient. Surg Laparosc Endosc Percutan Tech 2008; 18:626.
  33. Valade N, Decailliot F, Rébufat Y, et al. Thrombocytosis after trauma: incidence, aetiology, and clinical significance. Br J Anaesth 2005; 94:18.
  34. Ahmed R, Isaac AM. Postsplenectomy thrombocytosis and pseudohyperkalemia in trauma: a case report and review of literature. J Trauma 2009; 67:E17.
  35. Khan PN, Nair RJ, Olivares J, et al. Postsplenectomy reactive thrombocytosis. Proc (Bayl Univ Med Cent) 2009; 22:9.
  36. Chia TL, Chesney TR, Isa D, et al. Thrombocytosis in splenic trauma: In-hospital course and association with venous thromboembolism. Injury 2017; 48:142.
  37. Kwok AM, Davis JW, Dirks RC, et al. Time is now: venous thromboembolism prophylaxis in blunt splenic injury. Am J Surg 2016; 212:1231.
  38. Lin JN, Chen HJ, Lin MC, et al. Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study. Thromb Haemost 2016; 115:176.
  39. Mukherjee D, Lidor AO, Chu KM, et al. Postoperative venous thromboembolism rates vary significantly after different types of major abdominal operations. J Gastrointest Surg 2008; 12:2015.
  40. Murphy PB, Sothilingam N, Charyk Stewart T, et al. Very early initiation of chemical venous thromboembolism prophylaxis after blunt solid organ injury is safe. Can J Surg 2016; 59:118.
  41. Tinkoff G, Esposito TJ, Reed J, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg 2008; 207:646.
  42. Clancy TV, Ramshaw DG, Maxwell JG, et al. Management outcomes in splenic injury: a statewide trauma center review. Ann Surg 1997; 226:17.
  43. Livingston CD, Sirinek KR, Levine BA, Aust JB. Traumatic splenic injury: its management in a patient population with a high incidence of associated injury. Arch Surg 1982; 117:670.
  44. Shackford SR, Molin M. Management of splenic injuries. Surg Clin North Am 1990; 70:595.
  45. Boxer MA, Braun J, Ellman L. Thromboembolic risk of postsplenectomy thrombocytosis. Arch Surg 1978; 113:808.
  46. Watters JM, Sambasivan CN, Zink K, et al. Splenectomy leads to a persistent hypercoagulable state after trauma. Am J Surg 2010; 199:646.
  47. Stamou KM, Toutouzas KG, Kekis PB, et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins. Arch Surg 2006; 141:663.
  48. Gauer JM, Gerber-Paulet S, Seiler C, Schweizer WP. Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy. World J Surg 2008; 32:2730.
  49. Schwartz PE, Sterioff S, Mucha P, et al. Postsplenectomy sepsis and mortality in adults. JAMA 1982; 248:2279.
  50. Forsythe RM, Harbrecht BG, Peitzman AB. Blunt splenic trauma. Scand J Surg 2006; 95:146.
  51. Shatz DV. Vaccination practices among North American trauma surgeons in splenectomy for trauma. J Trauma 2002; 53:950.
  52. Linet MS, Nyrén O, Gridley G, et al. Risk of cancer following splenectomy. Int J Cancer 1996; 66:611.
  53. Kristinsson SY, Gridley G, Hoover RN, et al. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica 2014; 99:392.
  54. Mellemkjoer L, Olsen JH, Linet MS, et al. Cancer risk after splenectomy. Cancer 1995; 75:577.
  55. Sun LM, Chen HJ, Jeng LB, et al. Splenectomy and increased subsequent cancer risk: a nationwide population-based cohort study. Am J Surg 2015; 210:243.