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Splenic injury - non-op management?

trauma-list@trauma.org trauma-list@trauma.org
Mon, 4 Feb 2002 02:16:07 EST 

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At Kings County we obviously would have performed arteriography immediately 
after the CT scan showed a splenic injury as there is nothing on this CT scan 
that predicts the need for hemostasis. If the arteriogram shows no arterial 
injury or intrasplenic extravasation, he can avoid a stay in the ICU and be 
discharge in short order. If the arteriography showed intrasplenic 
extravasation, you could either observe him in an ICU and then operated if he 
continued to bleed, performed proximal splenic artery embolization at the 
time of the arteriogram and discharged him in 3 days or explored him right 
away.

Now that he returns to the hospital with a CT scan that shows recurrent 
subcapsular hematoma,  I would perform an arteriogram and embolization, even 
if no extravasation was seen on the angio. 

If he receives transfusion I would consider that failure of nonoperative 
management. No reason for such an injury to require transfusion.

If you don't have an angiographer willing to take care of this, shame them 
into learning or hire one.

Sal Sclafani

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<HTML><FONT FACE=arial,helvetica><BODY BGCOLOR="#ffffff"><FONT  style="BACKGROUND-COLOR: #ffffff" SIZE=2>At Kings County we obviously would have performed arteriography immediately after the CT scan showed a splenic injury as there is nothing on this CT scan that predicts the need for hemostasis. If the arteriogram shows no arterial injury or intrasplenic extravasation, he can avoid a stay in the ICU and be discharge in short order. If the arteriography showed intrasplenic extravasation, you could either observe him in an ICU and then operated if he continued to bleed, performed proximal splenic artery embolization at the time of the arteriogram and discharged him in 3 days or explored him right away.<BR>
<BR>
Now that he returns to the hospital with a CT scan that shows recurrent subcapsular hematoma,&nbsp; I would perform an arteriogram and embolization, even if no extravasation was seen on the angio. <BR>
<BR>
If he receives transfusion I would consider that failure of nonoperative management. No reason for such an injury to require transfusion.<BR>
<BR>
If you don't have an angiographer willing to take care of this, shame them into learning or hire one.<BR>
<BR>
Sal Sclafani</FONT></HTML>

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