A 28-year-old restrained front-seat passenger involved in a high-speed motor vehicle collision is haemodynamically stable. CT shows a grade III splenic laceration without active blush, no other intra-abdominal injuries. Per WSES (World Society of Emergency Surgery) and EAST guidelines, the appropriate management is:
- A Immediate splenectomy as grade III injury has high failure rate of non-operative management
- B Angioembolisation is mandatory for all grade III injuries regardless of haemodynamics
- C Non-operative management (NOM) is the treatment of choice for haemodynamically stable grade III splenic injury ✓
- D Diagnostic peritoneal lavage is required to exclude bowel injury before NOM
Explanation
WSES and EAST guidelines strongly endorse non-operative management (NOM) as the first-line treatment for haemodynamically stable blunt splenic injuries of any grade. NOM success rates for grade III splenic injury in stable patients exceed 85–90%. Angioembolisation is indicated when there is contrast blush on CT (extravasation of contrast indicating active arterial bleeding) or for high-grade injuries (grade IV–V) in stable patients, not universally for grade III without blush. Splenectomy is reserved for haemodynamic instability non-responsive to initial resuscitation or NOM failure. DPL has been largely replaced by FAST and CT.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.