Management of grade 3 splenic trauma in a stale child
Splenic organ injury scale Grade I- Nonexpanding subcapsular haematoma <10% surface area. Non-bleeding capsular laceration with <1 cm depth Grade II- Nonexpanding subcapsular haematoma 10-50% surface area. Nonexpanding intraparenchymal haematoma <2 cm Grade III- Expanding subcapsular or intraparenchymal haematoma. Bleeding subcapsular haematoma or subcapsular haematoma > 50% area or intraparenchymal haematoma >2 cm or parenchymal laceration >3 cm depth Grade IV- Ruptured intraparenchymal haematoma with active bleed; laceration involving segmental or hilar vessels with > 25% devascularisation Grade V- Shattered or avulsed spleen; hilar disconnection with entire spleen devascularisation. Clinically close observation, serial haematocrit evaluation, serial CT abdomen/U/S abdomen at regular intervals to assess the progress or regress of the bleeding spleen has to be done. * Absolute bed rest, sedation, antibiotic coverage and proper monitoring are needed. * It is often suppoed by angiographic embolisation to improve the splenic salvage rate. But it may cause pain, splenic abscess or infarction. * Indications for non-operative treatment - Only splenic injury - no other associated injuries.grade 1,2, and 3. Ref: SRB&;s manual of surgery,3 rd ed, pg no;603
Embolization
Paial splenoctomy
Total splenoctomy
Conservative
G.I.T