Diagnostic imaging and nonoperative therapy for splenic injury

Twenty-seven splenic injuries during the last six years were studied with regard to diagnosis by computed tomography (CT) and nonoperative therapy. CT is useful for the diagnosis of splenic injury. The majority of CT scans showed irregularity of the splenic margin and high and/or low area of attenuation in the splenic parenchyme. CT also showed five splenic fractures, one extravasation of contrast medium and one nonvisualization of spleen by contrast enhancement. Of 27 splenic injuries, operations were performed in 10 cases, and nonoperative therapies were initiated in the remaining 17. In the one case of delayed rupture, transcatheter embolization was added for hemostasis of active bleeding. Nonoperative therapy should be selecteded when the following conditions are fulfilled: 1) Stable vital signs and lack of signs of massive intraperitoneal hemorrhage, 2) correct diagnosis of splenic injury utilizing CT, 3) absence of ssociated abdominal injury that demands laparotomy, such as perforation of the alimentary tract, and 4) intensive care of the patient and lack of delay in shifting from nonoperative therapy to laparotomy. (author)