Surgery · Trauma and Emergency Surgery (ATLS, Burns, Abdominal Trauma, Head Injury)

Following penetrating abdominal trauma, a 22-year-old male has a Grade III splenic laceration on CT scan. He is hemodynamically stable with no other injuries. According to AAST organ injury scale criteria, what is Grade III splenic injury?

  • A Capsular tear < 1 cm depth
  • B Laceration > 3 cm depth or involving trabecular vessels
  • C Laceration 3–10 cm parenchymal depth not involving trabecular vessels
  • D Laceration involving segmental or hilar vessels causing > 25% devascularization
Correct answer: B. Laceration > 3 cm depth or involving trabecular vessels

Explanation

The AAST Organ Injury Scale for splenic injury: Grade I = subcapsular hematoma < 10% surface area or capsular laceration < 1 cm; Grade II = subcapsular hematoma 10–50% or parenchymal laceration 1–3 cm; Grade III = subcapsular hematoma > 50% or expanding, or parenchymal laceration > 3 cm or involving trabecular vessels; Grade IV = laceration involving segmental or hilar vessels with > 25% devascularization; Grade V = completely shattered spleen or hilar vascular injury with devascularization. Grades I–III in hemodynamically stable patients are candidates for non-operative management (NOM) with close monitoring.

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

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