Clinical Review

Modern management of splenic trauma

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1864 (Published 02 April 2014) Cite this as: BMJ 2014;348:g1864
  1. D R Hildebrand, specialty trainee in general surgery1,
  2. A Ben-sassi, consultant in colorectal surgery2,
  3. N P Ross, specialty trainee in general surgery1,
  4. R Macvicar, director of postgraduate general practice education3,
  5. F A Frizelle, professor of colorectal surgery2,
  6. A J M Watson, professor of colorectal surgery1
  1. 1Departments of Surgery, Raigmore Hospital, Inverness, IV2 3UJ, Scotland, UK
  2. 2Christchurch Public Hospital, Christchurch, New Zealand
  3. 3Postgraduate General Practice Education, NHS Education for Scotland, Inverness
  1. Correspondence to: A J M Watson angus.watson{at}nhs.net

Summary points

  • Initial resuscitation, diagnostic evaluation, and management of the trauma patient is based on protocols from Advanced Trauma Life Support (ATLS)

  • Further management of splenic injury depends on the haemodynamic stability of the patient

  • Splenic injury is graded (I through V) depending on the extent and depth of splenic haematoma and/or laceration identified on computed tomography scan

  • Low grade splenic injuries (I, II, and III) are suitable for non-operative management, although more recent evidence suggests that higher grades (IV and V) may also be suitable with the adjunct of angioembolisation

  • Early use (<72 hours post-injury) of chemical venous thromboprophylaxis in the form of low molecular weight heparin does not increase the risk of failure of non-operative management in splenic trauma, although no consensus exists on time post-injury to start treatment

Trauma is a major cause of morbidity and mortality; in the developed world, road traffic accidents are one of the leading causes. Up to 45% of patients with blunt abdominal trauma will have a splenic injury,1 which may require urgent operative management, angioembolisation, or non-operative management in the form of active observation.

The management of splenic injuries has evolved over the past three decades with the realisation of the importance of the spleen in immunological defence against encapsulated organisms and a better understanding of the role of non-operative management of splenic injuries. Such management has been aided by better diagnostic and monitoring facilities and by advances in interventional radiology. This article aims to review the best available evidence for the management of patients with blunt splenic trauma.

Sources and selection criteria

We did a literature review by searching the Medline database to locate English language articles, using the terms “blunt splenic injury,” “spleen,” “trauma,” “investigation,” “computed tomography,” “splenic angioembolisation,” and “non-operative management” and then by carrying out a hand search of reference lists of …

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