Spleen Trauma

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Text of Spleen Trauma

  • 1. Universidad de Guadalajara Centro Universitario Ciencias de la Salud Spleen TraumaGiovanna Lazcano Sherman Dr. Hctor Manuel Virgen Ayala November 2011 Dr. Benjamn Robles Mariscal
  • 2. Anatomy Develops from mesenchymal cells in the dorsal mesogastrium during the fifth week of gestation.
  • 3. Theperitoneum covering thespleen, except in the hilum.
  • 4. 7cm 150 gr.(80 -300 gr). 12 cm 3 4 cm
  • 5. Ligaments Gastrosplenic Splenophrenic Splenorenal Splenocolic
  • 6. Irrigation and venous drainage
  • 7. Histology/Physiology
  • 8. SplenicTrauma/Injury
  • 9. The spleen is the intra-abdominal organ most frequentlyinjured in blunt trauma.
  • 10. Splenic injury History of a blow, fall, or sports-related injury
  • 11. Splenectomy Was considered the only acceptablesurgical option for splenic injuries. Recently, nonoperative management have been considered adequate options in patients postsplenectomy syndrome
  • 12. Overwhelming postsplenectomy infection (OPSI) Sudden onset of symptoms. Rapid and fulminating course (12 to 18 hours). Fever. Nausea. Vomiting. Headache. Altered mental status. Mortality Is complicated by shock, 50% to 80% electrolyte imbalance, hypoglycemia, and polyvalent pneumococcal disseminated intravascular vaccine coagulation.
  • 13. The diagnosis is confirmed by ECO - CT(hemodynamic stability) or exploratory laparotomy(hemodynamic instability)
  • 14. Nonopertative Treatment Hemodynamic stability. 70% Normal abdominal examination. Absence of contrast extravasation on CT. Absence of other clear indications for exploratory laparotomy or associated injuries requiring surgical intervention. Absence of associated health conditions that carry an increased risk for bleeding (coagulopathy, hepatic failure, use of anticoagulants, specific coagulation factor deficiency) Injury grade I to III.
  • 15. Surgicaltreatment of a splenic injury depends on itsseverit the presence of shock, andassociated injuries.
  • 16. Organ Injury Scaling-American Association From Moore EE, Cogbill TH, Jurkovich GJ, et al: Organ injury scaling: Spleen and liver of the Surgery of Trauma (OIS-AAST) (1994 revision). J Trauma 38:323-324, 1995, with permission. Grade Injury Description I Haematoma: Subcapsular, 3cm parenchymal depth or involving trabecular vessels IV Laceration: Laceration of segmental or hilar vessels producing major devascularization (>25% of spleen) V Laceration: Completely shattered spleen Vascular: Hilar vascular injury which devascularized spleen
  • 17. Grade IV Grade V
  • 18. Capsular tears of the spleen can be controlledby compression only or by using topicalhemostatic agents.
  • 19. Deeper lacerations can be controlled with horizontal absorbable mattress sutures.
  • 20. Major lacerations involving less than 50% of the splenic parenchyma and not extending into the hilum can be treated by segmental or partial splenic resection.Resection is indicated only if the patient is stable and no other major injuries are present.
  • 21. More extensive injuries involving the hilum or the central portion of the spleenSplenectomy.