Splenic Laceration and Angioembolization of the Spleen

Spleen

Production of antibodies (leucocytes)

Release of a hormone that leads to the production of red blood cell from medula
Removal of iron from hemoglobin to be used in several body organs
Removal of the biliar pigments to be release as the bile by the liver

Classification
G ra d e 1
S u b c a p s u la r
h e m a to m a <
1 0 % o f s u rfa c e
a re a
L a c e ra tio n < 1
cm deep

G ra d e 2

G ra d e 3

G ra d e 4

G ra d e 5

S u b c a p s u la r
h e m a to m a 1 0
5 0 % o f s u rfa c e
a re a ,
in tra p a re n c h y m a
l h e m a to m a < 5
cm
L a c e r a tio n 1 3
cm deep and not
in v o lv in g a
tra b e c u la r
vessel

S u b c a p s u la r
h e m a to m a >
5 0 % o f s u rfa c e
a re a ,
in tra p a re n c h y m a
l h e m a to m a 5
cm , any
e x p a n d in g o r
ru p tu re d
h e m a to m a
L a c e r a tio n > 3
cm deep or
in v o lv in g a
tra b e c u la r
vessel

L a c e r a tio n
in v o lv in g
s e g m e n ta l o r
h ila r v e s s e ls a n d
th a t
d e v a s c u la riz e s >
2 5 % o f s p le e n

C o m p le te ly
s h a tte re d s p le e n
H ila r v a s c u la r
in ju ry th a t
d e v a s c u la riz e s
s p le e n

Causes

Penetrating Trauma
(Gunshot wound,
Knife wound)

Impact (Vehicle
Crash)

Epstein-Barr viral
disease

Haemorrha
ge

Haemorrhagic
Shock

Infectious
mononucleosis

 Signs and Symptoms

Left Abdominal Quadrant pain and

abdominal distension
Diagnosis

CT in stable
patients and with
bedside (point of
care)

ultrasonography or
exploratory
laparotomy in unstable
patients.

Treatment

Observation
Vital signs
Abdominal
distension
Hematocrit level

Angioembolization
Types: proximal, distal or both;
From the femoral artery to the splenic artery
a catheter is inserted and Gelfoam (Upjohn,
Inc., Kalamazoo, MI), particles, or coils can be
used in isolation or together.
For a proximal embolization procedure, the
goal of the embolization is to simply occlude
the main splenic artery to decrease the
perfusion pressure of the spleen while
allowing perfusion of the splenic tissue via
collateral pathways. Important collateral
pathways include short gastric arteries,
pancreatic arteries, gastroepiploic arteries,
and splenic capsular arteries. To preserve the
pancreatic collateral pathway, we specifically
place our coil pack just distal to the dorsal
pancreatic artery origin (typically in the
proximal third of the splenic artery). This
allows for perfusion of the spleen via the
dorsal pancreatictransverse pancreatic
arteria pancreatica magnasplenic artery
pathway; it is not at all uncommon to see
that pathway develop immediately after the
embolization procedure

Surgical repair or
splenectomy
Avoidable if
possible due to
high risk of post
op sepsis