A patient with blunt abdominal trauma has a grade III splenic laceration on CT (laceration >3 cm depth or involving hilar vessels) with active contrast extravasation (blush). He is hemodynamically stable. According to current WSES/EAST guidelines, the preferred management is:
- A Angioembolization (proximal or selective) followed by NOM ✓
- B Immediate splenectomy
- C Non-operative management (NOM) alone with serial abdominal exams
- D Exploratory laparotomy with splenorrhaphy
Correct answer: A. Angioembolization (proximal or selective) followed by NOM
Explanation
Current evidence (EAST, WSES 2020 guidelines) supports non-operative management for hemodynamically stable blunt splenic injuries. For Grade III–V injuries with active contrast extravasation ('blush') on CT, angioembolization (proximal splenic artery embolization or selective branch embolization) significantly improves NOM success rates (from ~60% to >85%). NOM alone without angioembolization for high-grade injuries with vascular blush has unacceptably high failure rates. Splenectomy is reserved for hemodynamic instability or NOM failure.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.