diaGnosis and ManaGeMenT of splenic TrauMa

The diagnosis and management of splenic trauma has evolved over the past several decades. The spleen, once thought expendable, is now viewed as a vital component of the immune system. Adult trauma surgeons have learned from their pediatric counterparts that non- operative management is possible even with higher grade injuries; interventional radiology has increased successes with non-operative approaches. Improvements in assessment of injuries with adjuncts such as the FAST exam and higher resolution CT scanners have allowed reliable identification of variables that can guide the surgeon either to immediate laparotomy, angiography, or a non-operative course. We outline in this review the evaluation, assessment, and management of splenic trauma. The current standard of non-operative management is discussed and demonstrated by the protocol used at Lancaster General Hospital. We also describe the technique of splenectomy and its complications. historical conteXt The great ancient Roman physician Galen described the spleen as “Plenum mysterii organum” or “the organ full of mystery” as he struggled to elucidate its function. The mystery continued for over a millennium, as no one challenged his theory that the spleen functioned to remove the evil humor “black bile” produced by the liver. 1 As understanding of physiology and anatomy improved, we learned that the spleen stored and removed aging red cells and platelets and produced opsonins, properdin, and tuftsin. East Indian criminals dubbed “Thugees” certainly appreciated the spleen as a storage site for cells, as they aimed to permanently incapacitate their victims with a blow to the left upper quadrant. Nonetheless, the presumed expendability of the spleen guided therapy during much of the last century, when marginally positive diagnostic peritoneal lavages frequently resulted in mandatory laparotomy and splenectomy. It appears that we have come full circle over the last several decades. Splenic salvage is once again considered appropriate, reinforced by the pediatric experience with successful non-operative management (NOM), an