Blunt splenic injury.
OBJECTIVE
To review the current care of the patient with an injured spleen.


RESULTS
The initial care of the patient with splenic injury is dictated by their hemodynamic presentation and the institution's resources. Although most high-grade injuries require splenectomy, up to 38% are successfully managed nonoperatively. Angioembolization has increased splenic salvage with a minimum of complications. In the absence of injuries that mandate longer hospital stays, patients with low-grade injuries are successfully discharged in 1-2 days and high-grade injuries in 3-4 days. Delayed splenic hemorrhage remains a feared complication, but fortunately the 180-day readmission rate for splenectomy is low with the majority of those returning within 8 days of injury.


CONCLUSIONS
Nonoperative management (NOM) is the standard of care for the hemodynamically stable patient with an isolated blunt splenic injury. Splenic salvage can be safely increased, even in higher grade injuries, with the use of angioembolization. Patients managed nonoperatively are successfully discharged as early as 1-2 days for low-grade injuries and as early as 3-4 days for higher grade. Safe management of the patient with blunt splenic injury requires careful selection for NOM, meticulous monitoring and follow-up.
Cocanour
Christine S
CS
University of California Davis Medical Center, Sacramento, California 95817, USA. Christine.cocanour@ucdmc.ucdavis.edu
D000792:Angiography / Q000379:methods; D002985:Clinical Protocols; D003657:Decision Making; D004621:Embolization, Therapeutic / Q000379:methods; D006439:Hemodynamics; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D022401:Meningococcal Vaccines / Q000008:administration & dosage; D010372:Pediatrics; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D012151:Resuscitation / Q000379:methods*; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery / Q000628:therapy*
D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines