Contemporary management of adult splenic injuries: What you need to know

The spleen is a frequently injured organ, with over 40,000 adult splenic injuries occurring yearly. It plays an important role in the body's immune system, so surgeons should make every effort to perform splenic salvage when able. In blunt injury, indications for emergent splenectomy have not recently changed and include hemodynamic instability and peritonitis. A computed tomography (CT) scan with intravenous contrast is the preferred imaging modality for hemodynamically normal patients and should be used to classify the grade of injury and identify active bleeding and its stigmata. Nonoperative management has been successful for all grades of blunt injury (80-95%), but it is the job of the surgeon to carefully select the patient, in the context of their age, other associated injuries, and splenic CT findings, so this success rate remains high. Angioembolization is an important tool for splenic salvage that should be used when an actively bleeding vessel is observed on CT scan. Both proximal and distal embolizations are effective with no data to suggest that one is superior to the other. All patients selected for nonoperative management require close monitoring, which can include interval CT scans for high-grade injuries. Penetrating splenic injuries differ from blunt injuries because they are more likely to be surgically explored on presentation and they have a higher operative splenorrhaphy rate.