A patient presenting to ER after 6 hrs of RTA hemodynamically stable. FAST POSITIVE, CECT shows leak of contrast from spleen and 3cm laceration in spleen. What is treatment ?
|C||Splenic artery embolization|
a. In the past splenic injury had been an absolute indication for spleenectomy.
b. Class 1 and a proportion of the less severe class2 can often be managed conservatively unless there are associated injuries or patient is hemodynamically unstable.
c. Vital signs and hematocrit need to be followed closely in ICU with physical examination. Repeated every 4-6 hrs.
d. The requirement of more than 2 units of blood to keep Hb above 8 gm% is an indication of operative management.
e. CT scan should be repeated after 12hrs, on 3day and 7 day.
f. The severe class 2 and 3 have better outcome with splenorrhaphy and class 4 often requires segmental splenectomy.
g. The class4 injuries require splenectomy. Splenectomy is preferred over splenography for patients with lesser injures but with medical contraindications for prolonged surgery.
h. The surgeon must base diagnosis and management of patient with splenic trauma primarily on clinical grounds. CT and ultrasound are imp.
a. Subcapsular hematoma <10% surface area, capsular laceration < 1cm in depth
b. Subcapsular ,10-50% hematoma, intraparenchymal <5cmhematoma or 1-3cm depth parenchymal laceration which doesn’t involve trabecular artery
c. Subcapsular >50%or expanding parenchymal hematoma or >3cm laceration with trabecular artery involvement
d. Laceration involving segmental or hilar vessel> 25%devascularizatio
e. Completely shattered spleen or hilar vascular injury which devascularize spleen.