A 35-year-old man with blunt abdominal trauma undergoes CT abdomen and is found to have a grade IV splenic laceration with active extravasation and haemodynamic stability on two successive readings 10 minutes apart. The appropriate management is:
- A Angioembolisation of the splenic artery ✓
- B Emergency splenectomy
- C Non-operative management (NOM) with observation in ICU
- D Splenorrhaphy (splenic repair)
Correct answer: A. Angioembolisation of the splenic artery
Explanation
AAST grade IV splenic injury (laceration >3 cm parenchymal depth with active bleeding) in a haemodynamically stable adult is an indication for angioembolisation (splenic artery embolisation), which has an 85–95% success rate and preserves the spleen. Active contrast extravasation on CT mandates angiographic intervention even with current haemodynamic stability, as these lesions have a high failure rate with observation alone. Operative management is reserved for haemodynamic instability unresponsive to resuscitation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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