A 28-year-old restrained driver has a CT scan showing grade III splenic injury with a 3 cm laceration involving trabeculae, no active blush. His hemodynamics are stable (BP 120/80, HR 88). The most appropriate management is:
- A Non-operative management (NOM) with observation in high-dependency unit ✓
- B Emergency splenectomy
- C Angioembolization
- D Diagnostic laparoscopy to assess splenic integrity
Correct answer: A. Non-operative management (NOM) with observation in high-dependency unit
Explanation
Hemodynamically stable patients with grade I–III splenic injuries (AAST grading) without vascular injury (no contrast blush) are managed by non-operative management (NOM), which succeeds in over 90% of grade III injuries. NOM involves bed rest, serial abdominal examination, NPO, and close monitoring. Angioembolization is added for grade IV/V injuries, active blush, or pseudoaneurysm. AAST grade III = laceration >3 cm depth involving trabeculae; grade IV = involves hilar vessels. 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.