Non-operative management of blunt splenic injury

Case contribution: Dr Radhiana Hassan


  • A 20 years old lady with no known medical illness
  • Involved in MVA, motorbike versus car
  • Complaint of headache, chest discomfort and left sided abdominal pain
  • BP=126/82 mmHg, PR=101 bpm, GCS=15/15
  • Hb=12.2 gm/dL and Serum amylase was normal
  • Admitted for observation. Cerebral concussion resolved
  • Upper abdominal pain persistent
  • Ultrasound abdomen done was reported as normal
  • Hb drop from 12.2 to 11.8 gm/dL
Ultrasound of abdomen shows no significant finding.
CT scan of abdomen pelvis post contrast in axial plane soft tissue window
CT scan axial plane lung window shows bibasal atelectasis

CT scan findings:

  • Left pleural effusion (white arrows) with bibasal atelectasis
  • No lung contusion or pneumothorax.  No rib fracture.
  • Laceration at lower pole of spleen (red arrows) and intraparenchymal hematoma
  • Minimal free fluid is seen surrounding the spleen
  • Free fluid also seen at pelvic region.
  • Other organs are normal. No  evidence of bowel injury.

Progress of patient:

  • Patient was managed conservatively
  • No blood transfusion required during admission
  • Discharged well 5 days later

Diagnosis: Grade II spleen injury


  • The management of blunt spleen injuries has changed from mainly operative intervention, to the current practice of selective non-operative management.
  • It is now the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury, patient age, or the presence of associated injuries.
  • Its use is associated with a low overall morbidity and mortality when applied to an appropriate patient population.
  • All hemodynamically stable patients are treated with observation, serial abdominal examination, and follow-up abdominal CT scanning whenever necessary.
  • This approach is selected even for higher grade of injuries (over 80% of grade 4 and 5 injuries were successfully managed nonoperatively).


Author: radhianahassan