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Splenic injury case

Karim Brohi karimbrohi at gmail.com
Sat Dec 27 20:44:11 GMT 2014


Miklosh hi

Assuming this patient has no on-going fluid requirements then she would be
suitable for observation.  There's no active bleed on CT so embolisation
would be proximal splenic artery to reduce overall flow.   I think the jury
is still out on whether proximal coil embolisation reduces the subsequent
splenectomy rate for these injuries although I think the evidence is
tending to support it.

Given this patient has previous surgery and has lost her short gastrics I
would avoid embolisation and just manage her conservatively( - and do a
splenectomy if she fails observation).

Karim

On Sat, Dec 27, 2014 at 8:31 AM, Miklosh Bala <mikloshbala at gmail.com> wrote:

> 22 yo female following car crush, on arrival HR 120, BP 90/60,
> seatbelt sign and posterior hip dislocation. Following resuscitation
> (crystalloids) and hip reduction, CT showed splenic rupture (Grade 4)
> -no active contrast extravasation.
> BP 100' HP 100. No other injury.
> The patient 2 years following Sleeve Gastrectomy.
> Do you thing angio is safe for this specific case? Short gastric
> arteries are divided - is that come to consideration?
>
> --
> Miklosh Bala, MD
> Head of Trauma and Acute Care Surgery Unit
> Hadassah - Hebrew University Medical Center
> Tel: (972) 26778800; Fax: (972) 26449412
> Email: mikloshbala at gmail.com
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