Subcapsular hematoma as a predictor of delayed splenic rupture.
Over the past 46 months at a level I trauma center, 966 computed tomography (CT) scans were performed for blunt abdominal trauma. Eighty-three (8.6%) demonstrated splenic injury, and 31 (3.2%) of these showed a subcapsular hematoma with or without associated parenchymal damage. Of the 31 patients, 23 were managed conservatively, based initially upon surgeons' preference (14 patients) and after March 1990 to conform to the authors' splenic trauma protocol (nine patients). The eight patients operated upon were hemodynamically stable and all underwent splenectomy. Subcapsular hematoma, as diagnosed by preoperative CT scan, was confirmed in each of the eight celiotomies. Parenchymal involvement, which had also been identified in these eight patients by CT, was evident at operation in all, and hilar involvement occurred in three. None of the 23 observed patients developed delayed splenic rupture. All were discharged home with outpatient follow-up in surgical clinic to at least 1 month without further complication. The authors came to the following conclusions: 1) Subcapsular hematoma is neither a predictor for delayed splenic rupture, nor by itself an indication for operative management of the injured spleen in the hemodynamically stable patient; 2) Degree of parenchymal injury based on CT morphology, specifically hilar involvement, signifies the need for laparotomy with splenectomy; 3) Splenorrhaphy has a reduced role in splenic trauma because most injuries now operated upon are severe.
Black
J J
JJ
Department of Surgery, Harbor-UCLA Medical Center.
Sinow
R M
RM
Wilson
S E
SE
Williams
R A
RA
D001803:Blood Transfusion / Q000706:statistics & numerical data; D002985:Clinical Protocols; D006400:Hematocrit; D006406:Hematoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D015141:Los Angeles / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000592:standards; D013161:Splenic Rupture / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000592:standards*; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy