Presentation
The patient, with no notable medical history, fell from an electric scooter at approximately 25 km/h. Subsequently, they developed abdominal pain, dizziness, and vomiting.
Patient Data
The lower pole of the spleen is shattered.
Associated with a large amount of hemoperitoneum.
The liver, pancreas, adrenal glands, kidneys, small and large bowel are normal.
No pneumoperitoneum or intra-abdominal collection.
No rib fractures.
IMPRESSION: AAST grade 5 splenic injury.
Case Discussion
The case described above corresponds to a grade 5 splenic trauma, as it involved a shattered spleen with active bleeding and massive hemoperitoneum. Consequently, the patient experienced hypovolemic shock and required urgent surgery, leading to splenectomy.
In recent years, there has been a tendency to manage traumatic spleen injuries conservatively, with observation and imaging checks every 24 to 48 hours. In selected cases of grade 3 or 4 traumatic injuries, splenic artery embolization can be considered a therapeutic option - an increasingly utilized approach due to advances in interventional radiology. However, emergency splenectomy is necessary for grade 5 injuries.
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