Differences in Management and Outcomes in Atraumatic Splenic Rupture Compared to Traumatic Injury Following Blunt...

Area of Science:

• Trauma Surgery
• Abdominal Imaging
• Emergency Medicine

Background:

• Splenic lacerations result from trauma or atraumatic causes.
• Treatment and outcomes may differ based on etiology.
• Optimal management strategies require further investigation.

Purpose of the Study:

• To compare treatment strategies and outcomes for traumatic versus atraumatic splenic lacerations.
• To identify prognostic factors influencing therapy success and mortality.

Main Methods:

• Retrospective analysis of 291 patients with splenic lacerations confirmed by CT scan (01/2010-03/2023).
• Exclusion of patients with missing data or early death.
• Evaluation of etiology, demographics, clinical parameters, and American Association for the Surgery of Trauma (AAST) scores.

Main Results:

• Atraumatic splenic lacerations (50/291) showed a higher incidence of moderate/high-grade injuries (90% vs. 58%).
• Conservative treatment was less successful in atraumatic cases (75% vs. 94.5%) with higher surgical conversion rates (10% vs. 1%).
• Splenic artery embolization (SAE) had lower success in atraumatic injuries (87% vs. 97%), but fewer AAST grade 3 injuries required primary SAE.

Conclusions:

• Atraumatic splenic injuries require distinct management from traumatic ones.
• Early consideration of SAE or surgery for moderate atraumatic splenic injuries is recommended.
• Interdisciplinary evaluation and case-by-case management are crucial due to higher expected mortality from comorbidities.