New horizons in splenic traumatism management: literature review

Review of the new horizons of management for splenic trauma and a proposal of an algorithm for its management.

Literature review using PubMed search engines using the keywords splenic trauma, splenic angioembolisation, management.

Non-operative management (NOM) is the first strategy in stable patients with splenic traumatic injury. In AAST grade I-II patients’ observation with close monitoring should be considered. Endovascular management (EVM) improves the results of NOM and should be consider in AAST III-IV grade when its available. Fail of NOM should be considered when there are clinical, analytical or imagine signs of active bleeding. Surgery is mandatory in unstable patients. Also is indicate when NOM fails, in grade III-IV stable patients if EVM is unavailable, AAST grade V or if associated injuries that are suspected. Laparoscopy have probe to be a feasible and safe technique in stable trauma patients. Preserving the organ when possible is the trend in surgical strategy of splenic trauma.

The EVM has improve the success of NOM and it’s recommended in AAST grade III-V when its possible. The risk of NOM failure and its early detection must be taken into account. Laparoscopy is safe in stable trauma patients. Open splenectomy remains the gold-standard for unstable patients.