Diagnosis is confirmed with CT, or bedside ultrasound for less stable patients. Exploratory laparotomy is rarely used, though it may be of benefit in patients with particularly severe hemorrhage to assess for any retroperitoneal hematomas. An exploratory laparotomy is an opportunity to assess the four quadrants of the abdomen and to look at the bowel for any perforations, vascular injuries, or abnormalities. A set of CT scan grading criteria was created to identify the need for intervention (surgery or embolization) in patients with splenic injury. The criteria were established using 20 CT scans from a database of hemodynamically stable patients with blunt splenic injury. These criteria were then validated in 56 consecutive patients retrospectively and appear to reliably predict the need for invasive management in patients with blunt injury to the spleen (sensitivity of 100%, specificity 88%, overall accuracy was 93%). The study suggested that the following three CT findings correlate with the need for intervention: # Devascularization or laceration involving 50% or more of the splenic parenchyma # Contrast blush greater than one centimeter in diameter (from active extravasation of IV contrast or pseudoaneurysm formation) # A large hemoperitoneum.
Blunt splenic trauma
Blunt kidney trauma
Splenic injury
Pancreatic injury
Splenic infarction
Pulmonary laceration
Traumatic aortic rupture
Hemoperitoneum