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Splenic injury - non-op management?

trauma-list@trauma.org trauma-list@trauma.org
Sun, 03 Feb 2002 15:52:55 EST 

Dr Shafi--
How the CT looks really does not matter--the patient's hemodynamic stability, without sign of bleeding in his clinical presentation, is simply confirmed by what you see in your images, and nonop management was appropriate.
His re-presentation suggests some expansion of blood in his abdomen--again, the CT adds nothing to this.  Some instability in the way of tachycardia supports this--at this point are the options of transfusion, tho a Hgb of 9.9 does not suggest much blood loss.  One option here where available is angioembolization to stop whatever continued bleeding may be occurring, which has the chance of allowing avoidance of surgery.  If transfusion does not stabilize, and angio not available or does not work, then splenectomy should be done.
ERF