Ver el código de «Splenic trauma»

==Background==
*Most commonly injured visceral organ in blunt trauma 

==Clinical Features==
*[[LUQ pain]]
*Signs of [[shock]]
*[[Hypotension]]
*Left lower [[chest wall pain|rib pain]]
*Kehr's sign
**Acute pain in the tip of the shoulder due to the presence of blood in the peritoneal cavity when a patient's legs are elevated while laying flat.

==Differential Diagnosis==
{{Abdominal trauma DDX}}

==Evaluation==
[[File:Milzruptur - Computertomographie axial - pv-Kontrastphase 001.jpg|thumb|Traumatic rupture of the spleen on contrast enhanced axial CT (portal venous phase).]]
[[File:SpleenHematomaAndBloodAbdoCor.png|thumb|Splenic hematoma (red arrow) resulting in free abdominal blood (blue arrow).]]
{{ATLS abd trauma diagnosis algorithm}}

===AAST Criteria===
{| class="wikitable" 
| align="center" style="background:#f0f0f0;"|'''Grade'''
| align="center" style="background:#f0f0f0;"|'''Hematoma'''
| align="center" style="background:#f0f0f0;"|'''Laceration'''
|-
| I||
*Subcapsular, <10% of surface area
||
*Capsular tear <1 cm in depth into the parenchyma
|-
| II||
*Subcapsular, 10-50% of surface area
||
*Capsular tear, 1 to 3 cm in depth, but not involving a trabecular vessel
|-
| III||
*Subcapsular, >50% of surface area OR expanding, 
*Ruptured subcapsular or parenchymal hematoma 
*OR, intraparenchymal hematoma >5 cm or expanding
||
*Capsular tear, 3 to 10 cm in depth or involving a trabecular vessel.
|-
| IV|||
*Subcapsular or central hematoma > 10cm
||
*Involving segmental or hilar vessels with major devascularization (i.e. >25% of spleen)
|-
| V||
*Shattered spleen
||
*Hilar vascular injury which devascularizes spleen.
|}
Interactive calculators have been developed that facilitate grading of splenic injuries per AAST guidelines.<ref> [https://radathand.com/radiology-calculators/emergency-radiology-calculator/spleen-trauma-injury-score-aast/ Spleen trauma injury score calculator]- ''Rad At Hand''  </ref>

==Management==
*Observation, angiographic embolization, or surgery depending upon:
**Hemodynamic status of the patient
**Grade of splenic injury
**Presence of other injuries and medical comorbidities
*Operative Management
**Indicated for diffuse peritonitis or hemodynamic instability after blunt abdominal trauma
**Not indicated based on injury grade alone<ref>Stassen N, Bhullar I, Cheng J, et al. Selective nonoperative management of blunt splenic injury: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73(5):s293-s300</ref>
*Nonoperative management
**Failure rate of 10-15% 
**Some advocate nonoperative management only if <55yr and CT injury grade less than IV
**Should only be considered in locations with resources available for urgent laparotomy

==Disposition==
*Admit

==See Also==
*[[Abdominal Trauma]]
*[[Splenic Infarction]]

==References==
<References/>

[[Category:Trauma]]