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Spleen, Liver, Kidney Trauma

Approach to abdominal trauma has been discussed earlier.

“Subcostal Transducer Position” by iem-student.org is licensed under CC BY-NC-SA 2.0.
Spleen InjuryLiver InjuryKidney Injury
General2nd m/c injured intra-abdominal organ in blunt trauma

m/c injury requiring operative intervention in blunt trauma
m/c injured intra-abdominal organ overall

m/c injured intra-abdominal organ in blunt trauma
m/c from blunt trauma

maximum warm ischemia time if clamping is 20-30 minutes
Grade
Is/c hematoma <10%
Laceration <1 cm
s/c hematoma <10%
Laceration <1 cm
s/c hematoma
IIs/c hematoma 10-50%
Laceration 1-3 cm
s/c hematoma 10-50%
Laceration 1-3 cm
s/c hematoma
Laceration ≤1 cm
IIIs/c hematoma >50%
Laceration >3 cm
s/c hematoma >50%
Laceration >3 cm
Laceration >1 cm
IV>25% vascular loss (hilum injury)Laceration 25-75% hepatic lobe or 1-3 Couinaud’s segments

Active hepatic hemorrhage with extension into peritoneum
Partial vascular loss (injury to medulla)

Laceration into urine collecting system with urine extravasation
VComplete vascular loss
Shattered spleen
Laceration >75% hepatic lobe or >3 Couinaud’s segments

Juxtahepatic venous injuries (retrohepatic venacava/central major hepatic veins)
Complete vascular loss
Shattered kidney
Treatment
UnstableLaparotomyLaparotomyLaparotomy +/- IVP/IVU
StableCECTCECTCECT
a. Contrast leak/PseudonaeurysmAngioembolizationAngioembolization
b. Grade I/IIObservationObservationObservation
c. Grade IIIObservation vs AngioembolizationObservation vs Angioembolization
c. Grade IV/VAngioembolizationAngioembolizationAngioembolization
d. Failure of angioembolizationLaparotomyLaparotomyLaparotomy

Mnemonics:

  1. Spleen and Liver injury mnemonic: I/II/III – 1/2/3 cm depth
  2. Kidney injury mnemonic: IV (Four) – urinate on the Floor (extravasation)
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