A 30-year-old motorcyclist sustains blunt abdominal trauma. CT abdomen shows splenic injury with a blush (active extravasation) with laceration involving >50% parenchymal disruption but no devascularisation. AAST Grade IV splenic injury. He is haemodynamically stable (BP 110/70 mmHg, HR 90 bpm). Optimal management per current EAST/WSES guidelines is:
- A Non-operative management with angiography and splenic artery embolisation ✓
- B Emergency splenectomy
- C Non-operative management with strict observation only (no embolisation needed for stable Grade IV)
- D Delayed splenectomy at 48 hours after stabilisation
Explanation
WSES and EAST guidelines support non-operative management (NOM) for haemodynamically stable blunt splenic injuries including Grade IV, with splenic artery embolisation (SAE) as an adjunct to improve NOM success rates. CT blush (vascular contrast extravasation) in Grade IV injury is an indication for angioembolisation even in stable patients because it significantly reduces NOM failure rates. SAE is now standard for high-grade splenic injuries (Grade III-V) with vascular injury on CT in stable patients. Emergency splenectomy is reserved for haemodynamically unstable patients failing resuscitation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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