In a polytrauma patient who is haemodynamically stable, a CT of the abdomen shows a Grade IV splenic laceration with an area of active arterial contrast extravasation ('blush'). The most appropriate next step is:

• A Immediate splenectomy
• B Splenic artery embolisation ✓
• C Observation with serial CT scans
• D Diagnostic peritoneal lavage

Explanation

A splenic artery blush on CT in a haemodynamically stable patient is an indication for angiographic embolisation, which achieves splenic salvage while controlling haemorrhage. Immediate splenectomy is reserved for haemodynamic instability or failed embolisation. Grade IV lacerations are too severe for simple observation. DPL is outdated in the era of CT.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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