Spleen, Liver, Kidney Trauma

Approach to abdominal trauma has been discussed earlier.

	Spleen Injury	Liver Injury	Kidney Injury
General	2nd 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
I	s/c hematoma <10% Laceration <1 cm	s/c hematoma <10% Laceration <1 cm	s/c hematoma
II	s/c hematoma 10-50% Laceration 1-3 cm	s/c hematoma 10-50% Laceration 1-3 cm	s/c hematoma Laceration ≤1 cm
III	s/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
V	Complete 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
Unstable	Laparotomy	Laparotomy	Laparotomy +/- IVP/IVU
Stable	CECT	CECT	CECT
a. Contrast leak/Pseudonaeurysm	Angioembolization	Angioembolization
b. Grade I/II	Observation	Observation	Observation
c. Grade III	Observation vs Angioembolization	Observation vs Angioembolization
c. Grade IV/V	Angioembolization	Angioembolization	Angioembolization
d. Failure of angioembolization	Laparotomy	Laparotomy	Laparotomy

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)