A 25-year-old motorcyclist with polytrauma has a Grade III splenic laceration on CT (laceration >3 cm parenchymal depth, involving segmental vessels). He is hemodynamically stable with no active blush on CT angiography. What is the preferred management?
- A Non-operative management (NOM) with angioembolization ✓
- B Urgent splenectomy
- C Surgical exploration and splenorrhaphy
- D Observation alone with serial abdominal exams in ICU
Explanation
In hemodynamically stable patients with blunt splenic injuries (AAST Grades I–V), non-operative management is the standard approach, with angioembolization indicated for Grade III–V injuries, active extravasation, or vascular abnormalities on CT. The AAST Organ Injury Scaling (OIS) system guides management: Grade III–IV injuries in stable patients benefit from proximal or selective splenic artery embolization, reducing NOM failure rates from 20% to approximately 10%. Splenectomy is reserved for hemodynamic instability, NOM failure, or Grade V injury with near-complete disruption. Observation alone (without embolization) for Grade III has higher failure rates.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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