Unstable Splenic Injury, No Time for CT-Imaging!

Abstract

Aims: To highlight the importance of early surgical intervention in splenic trauma following blunt abdominal impact, particularly in the setting of hemodynamic instability after motor vehicle accidents (MVAs). Presentation of Case: A 28-year-old male with no prior medical history presented in haemorrhagic shock following an MVA. Initial vitals indicated hypotension and tachycardia, and FAST ultrasound revealed significant intra-abdominal free fluid. Hemoglobin levels dropped from 14.4 g/dL to 8 g/dL. Due to hemodynamic deterioration, an urgent exploratory laparotomy was performed, revealing a ruptured spleen with active bleeding. A hemostatic splenectomy was conducted. The patient had an uneventful recovery and was discharged on postoperative day six. Discussion: While non-operative management (NOM), including splenic artery embolization, is effective in hemodynamically stable patients, it is contraindicated in unstable cases. Clinical signs of ongoing bleeding—particularly persistent hypotension—require immediate surgical intervention. FAST is valuable for rapid assessment but should not delay operative care when instability is evident. Conclusion: In blunt abdominal trauma with shock, early surgical decision-making is critical. Timely intervention based on clinical evaluation rather than imaging can significantly reduce morbidity and mortality. Splenectomy, though associated with long-term immune considerations, remains a life-saving procedure in unstable trauma patients.