eMedicine Specialties > Trauma > Abdominal Trauma

Splenic Rupture: Follow-up

Author: H Scott Bjerke, MD, FACS, Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine, Medical Director of Trauma Services, Methodist Hospital, Clarian Health Partners, Inc
Coauthor(s): Janet S Bjerke, RN, MBA, CCRC, Research Coordinator, Trauma Services, Methodist Hospital of Indianapolis
Contributor Information and Disclosures

Updated: Aug 6, 2009

Outcome and Prognosis

Recent multi-institutional studies by the Eastern Association for the Surgery of Trauma demonstrate that mortality from splenic injury still occurs, even in Level 1 trauma centers. Overall, outcome from grade 1-2 splenic injuries remains excellent but not perfect, and outcome worsens as the injury grade increases.

Prognosis is usually excellent, but those patients left asplenic by their injuries and surgery increase the risk of fatal and debilitating infection for the remainder of their lives.

Numerous papers have recently emerged in the literature comparing the practice and the outcome in different levels of trauma centers and comparing trauma and nontrauma centers.19,20,21

The risk of complications or failure of nonoperative management appears to be worse in patients older than 55 years, and women older than 55 years are significantly more likely to fail nonoperative management with an increased mortality.

Multisystem injury or concomitant liver, pancreas, or bowel injury increases the likelihood of splenectomy. Improved splenic trauma care and salvage rates can be shown in both trauma centers and nontrauma centers, though treatment pattern differences are evolving. Operative treatment with isolated injury is more likely at low-volume centers, but overall salvage rates for nonoperative management are similar between low- and high-volume centers.

Isolated splenic injury is more likely to have nonoperative or interventional radiologic management in a trauma center, but observant management is also more costly in these centers. Patients with multisystem injury in informal and formal trauma systems are more likely to be transferred to a trauma center, and splenic salvage rates in these patients are less than with isolated injury.

Future and Controversies

Improvements in diagnostic technology, such as helical CT scanners and portable ultrasound, will go far to diagnose and stratify risk in patients with splenic injury. Future multi-institutional trials and data collection may make it possible to better identify those patients at risk for persistent bleeding and to minimize the need for operative intervention and splenectomy in all but a few patients. Improvements in knowledge of immunology may lead to more effective immunizations for patients who are asplenic and further minimize their risk of deadly infection.

Increased availability and ease of access to interventional radiologic equipment and personnel, especially in rural hospitals, may salvage splenic injuries that previously required operative intervention and splenectomy.

The controversy over when to operate, when to embolize and when to observe will likely continue for the next millennium, but the debate will spur the continued development of diagnostic and evaluative tools, further minimizing morbidity and mortality caused by splenic injury.

 


More on Splenic Rupture

Overview: Splenic Rupture
Workup: Splenic Rupture
Treatment: Splenic Rupture
Follow-up: Splenic Rupture
Multimedia: Splenic Rupture
References
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Further Reading

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Keywords

splenic rupture, ruptured spleen, rupture of the spleen, abdominal injury, blunt solid organ injury, splenic injury, diagnostic peritoneal lavage, DPL, splenorrhaphy, splenectomy, focused abdominal sonographic technique, FAST

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Contributor Information and Disclosures

Author

H Scott Bjerke, MD, FACS, Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine, Medical Director of Trauma Services, Methodist Hospital, Clarian Health Partners, Inc
H Scott Bjerke, MD, FACS is a member of the following medical societies: American Association for the History of Medicine, American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Midwest Surgical Association, National Association of EMS Physicians, Pan-Pacific Surgical Association, Royal Society of Medicine, Southwestern Surgical Congress, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Janet S Bjerke, RN, MBA, CCRC, Research Coordinator, Trauma Services, Methodist Hospital of Indianapolis
Janet S Bjerke, RN, MBA, CCRC is a member of the following medical societies: Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Lewis J Kaplan, MD, FACS, FCCM, FCCP, Director, SICU and Surgical Critical Care Fellowship, Associate Professor, Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University School of Medicine
Lewis J Kaplan, MD, FACS, FCCM, FCCP is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Association for Surgical Education, Connecticut State Medical Society, Eastern Association for the Surgery of Trauma, International Trauma Anesthesia and Critical Care Society, Society for the Advancement of Blood Management, Society of Critical Care Medicine, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert L Sheridan, MD, Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School
Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

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