A 40-year-old man sustains blunt abdominal trauma and is haemodynamically stable. CT of the abdomen reveals a Grade III splenic laceration (laceration >3 cm depth or involving trabecular vessels). He has no other abdominal injuries and the spleen appears contained. What is the current management approach per EAST and WSES guidelines?
- A Emergency splenectomy is mandatory for Grade III or higher
- B Immediate diagnostic laparoscopy followed by splenorrhaphy
- C Non-operative management (NOM) with close monitoring and selective angioembolisation if indicated ✓
- D CT-guided percutaneous drainage of the splenic haematoma
Correct answer: C. Non-operative management (NOM) with close monitoring and selective angioembolisation if indicated
Explanation
In haemodynamically stable patients, non-operative management (NOM) is the standard of care for blunt splenic injury regardless of grade per EAST and WSES 2022 guidelines. Grade III injuries may require angiographic embolisation (splenic angioembolisation) if there is evidence of contrast blush (vascular injury) on CT, which reduces failure rates of NOM from ~30% to ~10%. Emergency splenectomy is reserved for haemodynamically unstable patients who do not respond to resuscitation. The NOM success rate for Grade III is approximately 75–80%.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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