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This scan of an 18 year old followed an injury to the left lower chest.
This abdominal CT scan shows complete division of the spleen with extravasation of blood into the peritoneal cavity. Surprisingly the patient remained stable and was treated conservatively. There is a risk of late rupture which can occur even months after the original injury.
What does it show?
How is it managed?
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(See below for further details)
Increasingly surgeons are attempting to manage splenic injury by conservative means where possible. This can only be recommended when the patient remains cardiovascularly stable following injury. Prospective studies have shown that when ultrasound scan detects splenic injury, then there is an increased risk of the need for splenectomy. However, the above case demonstrates that even with bisection of the spleen and clear extravasation of blood into the peritoneum, there is still a possibility of conservative management. When surgery is undertaken, in most cases an open laparotomy is performed although there are some reports of laparoscopic assessment preceding to laparoscopic splenectomy if indicated. There are also some reports of splenic repair and placing splenic fragments which remain vascularised into a bag of absorbable material to promote haemostasis. In younger patients there is perceived to be more benefit for splenic conservation. In adult practice open splenectomy, however, remains the most common management option in confirmed splenic injury.