AAST grade IV splenic injury (major devascularization >25% of spleen) in a 28-year-old haemodynamically stable blunt trauma patient. According to current EAST and WSES guidelines, the preferred management is:
- A Non-operative management (NOM) with angioembolisation if contrast blush is present on CT, with ICU monitoring ✓
- B Emergency splenectomy regardless of haemodynamic status in grade IV injury
- C Splenorrhaphy (surgical repair) via open laparotomy
- D Repeat CT in 6 hours; surgery only if haemoglobin drops >2 g/dL
Explanation
Current EAST and WSES guidelines support non-operative management for haemodynamically stable blunt splenic injuries regardless of grade (I-IV), provided CT imaging is available and a high-dependency setting exists. A contrast blush on CT (indicating active extravasation or pseudoaneurysm) is an indication for angioembolisation, which significantly increases the success rate of NOM in grade III-IV injuries (success rate ~80-90%). Splenectomy is reserved for haemodynamic instability unresponsive to resuscitation. Spleen preservation is preferred due to risk of overwhelming post-splenectomy infection (OPSI) from encapsulated organisms.
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.