Management of Splenic Laceration

Initial Assessment and Hemodynamic Status

The American College of Surgeons recommends determining hemodynamic stability, defined as systolic blood pressure ≥90 mmHg without signs of skin vasoconstriction, altered consciousness, or shortness of breath, for patients with splenic laceration 2
Hemodynamic stability is also defined as no requirement for vasopressor support or continuous transfusions, and appropriate response to initial fluid resuscitation, for patients with splenic laceration 2

The World Society of Emergency Surgery recommends contrast-enhanced CT scan as the gold standard for diagnosing splenic injuries, with 96-100% sensitivity and specificity 5
The Eastern Association for the Surgery of Trauma recommends E-FAST for unstable patients who cannot undergo CT, with 91% sensitivity but 42% false-negative rate 5

The Western Trauma Association recommends non-operative management (NOM) for hemodynamically stable patients with splenic laceration, with success rates of 90-100% in appropriate settings 1, 2, 3
NOM should only be attempted in facilities with 24/7 availability of operating room and trained surgeons, immediate access to angiography/angioembolization, continuous monitoring capability in ICU setting, and immediate blood product availability 1, 2, 4

The Society of Interventional Radiology recommends angioembolization as first-line intervention in hemodynamically stable patients with arterial blush on CT, irrespective of injury grade 2, 4
Angioembolization should be considered in all hemodynamically stable patients with Grade III lesions, even without CT blush, according to the World Society of Emergency Surgery 4

The American College of Surgeons recommends immediate operative intervention for hemodynamically unstable patients, those with peritonitis on examination, bowel evisceration or impalement, or other injuries requiring laparotomy 1, 2, 3

The Eastern Association for the Surgery of Trauma recommends intensive monitoring for patients with high-risk factors, including age >55 years, high Injury Severity Score (ISS), moderate-severe splenic injuries (Grade III-IV), large hemoperitoneum, low admission hematocrit, associated traumatic brain injury, and anticoagulation therapy 2, 4

The Western Trauma Association recommends immediate or delayed surgery for patients with hemodynamic instability despite resuscitation, failure of NOM with persistent hemorrhage despite angioembolization, significant drop in hematocrit requiring continuous transfusions, or development of peritonitis or other surgical complications 2, 4

The American College of Surgeons recommends repeat CT scan for patients with moderate-severe lesions, decreasing hematocrit, vascular anomalies, or coagulopathy, and routine post-discharge imaging is not indicated in uncomplicated cases 4, 6
The Eastern Association for the Surgery of Trauma recommends against discharging patients too early, as delayed rupture risk persists for 3 weeks, with an incidence of 0.2-0.3% 4

The American Pediatric Surgical Association recommends non-operative management for hemodynamically stable children with isolated splenic injury, with a success rate of 95-100%, and splenectomy should be avoided in these patients 1, 3
The World Society of Emergency Surgery recommends contrast blush on CT is not an absolute indication for splenectomy or angioembolization in children, and low-dose CT protocols are preferred to minimize radiation exposure 1, 3