A 35-year-old male with blunt abdominal trauma has CT showing a grade IV splenic laceration with a 3 cm pseudoaneurysm and active haemorrhage (contrast blush). ATLS guidelines support which of the following interventions as the FIRST choice in a haemodynamically stable patient?

• A Splenic artery embolisation ✓
• B Emergency splenectomy
• C Observation with serial imaging
• D Diagnostic peritoneal lavage

Explanation

In a haemodynamically stable patient with high-grade splenic injury (grade III–V) and evidence of vascular injury (pseudoaneurysm or active extravasation), splenic artery embolisation (SAE) is the preferred non-operative management (NOM) strategy. It reduces the failure rate of NOM from ~30% to <10% for high-grade injuries. Splenectomy is reserved for haemodynamic instability or failed embolisation. Observation alone is insufficient for grade IV injury with a pseudoaneurysm.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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