[Splenectomy via the Transdiaphragmatic Approach].

Area of Science:

• Trauma Surgery
• Surgical Innovation
• Emergency Medicine

Background:

• Splenic injuries are common in blunt chest and abdominal trauma.
• Fractures of the left 9th to 11th ribs can lead to splenic injury.
• Early diagnosis and management are crucial for patient outcomes.

Observation:

• A 65-year-old male presented with blunt trauma, multiple left rib fractures, left hemothorax, and splenic injury.
• Hemodynamic instability and significant blood loss necessitated emergency left thoracotomy.
• Unexpected findings included a perforated left lung lobe and diaphragmatic ruptures.

Findings:

• Sutures repaired the lung perforation; phrenotomy addressed diaphragmatic ruptures.
• A surprising central splenic rupture required splenectomy.
• Chest wall stabilization was performed post-splenectomy.

Implications:

• The transthoracic approach for splenic injury via phrenotomy is not standard but beneficial in select cases.
• This case demonstrates the complexity of managing concomitant chest and upper abdominal trauma.
• Spleen preservation may not always be feasible in severe blunt trauma scenarios.