A 30-year-old motorcyclist sustains blunt abdominal trauma. FAST ultrasound shows free fluid in Morrison's pouch. He is haemodynamically stable. CT shows a grade IV splenic laceration involving segmental vessels with active haemorrhage. The preferred management is:

• A Emergency splenectomy
• B Angioembolisation of splenic artery ✓
• C Observation with serial CT at 48 hours
• D Non-operative management with continuous monitoring without embolisation

Explanation

In haemodynamically stable patients with high-grade splenic injuries (Grade III–V) showing active contrast blush on CT, angioembolisation (proximal or selective) achieves haemostasis in over 80% of cases and preserves splenic function. Immediate operative splenectomy is reserved for haemodynamic instability. Grade IV injuries with vascular involvement specifically benefit from angioembolisation over pure observation alone.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.