A 40-year-old male cyclist with a seatbelt injury undergoes CT abdomen showing Grade III splenic laceration with active blush, no haemoperitoneum, haemodynamically stable. What is the management as per WSES (World Society of Emergency Surgery) 2017 guidelines?

• A Emergency splenectomy (haemodynamically unstable criterion met by blush)
• B Observation only; active blush resolves spontaneously in 80% of cases without embolisation
• C Laparoscopic splenorrhaphy (repair) as first-line for Grade III injury with blush
• D Non-operative management (NOM) with angioembolisation (AE) of the active blush ✓

Explanation

WSES and AAST guidelines support non-operative management (NOM) for haemodynamically stable splenic injuries regardless of grade, with angioembolisation (AE) indicated for CT evidence of active vascular injury (contrast blush, pseudoaneurysm, arteriovenous fistula). Grade III splenic injury with active blush in a stable patient is the classic indication for angioembolisation, which achieves haemostasis while preserving splenic immune function. Splenectomy is reserved for haemodynamic instability not responding to resuscitation or failed NOM. Observation alone (without embolisation) carries unacceptable re-bleeding risk when a vascular blush is demonstrated on CT.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.