Penetrating wound Abdomen-Splenic Injury

Penetrating wound Abdomen- Splenic Injury



Penetrating Stab Injury Abdomen



Management of Splenic Injury

Primary Survey and Resuscitation

      A- Airway maintenance with control of Cervical Spine

      B- Breathing

      C-Circulation-Intravenous Fluids

      D- Dysfunction of CNS Assessment

      E- Exposure in the Controlled Environment

Secondary Survey :- Detailed Head to Foot Examination Head to find out other associated Injuries:-

q Face

q Chest

q Abdomen

q Pelvis and Perineum

q Extremities

q General examination of vital signs

q Local Inspect anterior abdomen, lower thorax, perineum

q Log roll to inspect posterior abdomen.

Definitive care - Investigations and Treatment

  

Signs of Abdominal Trauma

Ø Tachycardia

Ø Hypotension

Ø Pallor

Ø Restriction of Abdominal Movements

Ø Grey Turners Sign/ Cullen’s Sign

Ø Rigidity

Ø Ballance’s Sign

Ø Absence of Bowel Sounds

What is Ballance’s Sign?

Ø Shifting Dullness on the Right of Abdomen

Ø Dull note on Percussion on the Left of Abdomen

Ø Due to Early Coagulation of Blood in the Left of Abdomen in Splenic Trauma

What is the difference between Guarding and Rigidity ?

Ø Guarding is the voluntary contraction of the abdominal wall muscles

Ø Rigidity is the involuntary contraction of the abdominal wall muscles

What are the treatment options available for Splenic Injury?

Non Operative Management ( Preferred)

Splenorraphy

Partial Splenectomy

Splenic Auto Transplantation

Splenectomy

What is the rationale of opting for Non Operative Management?

1.     To avoid complications with splenectomy like iatrogenic injury to the pancreas.

2.     To avoid immunosuppressive effects of Splenectomy-like OPSI ( Overwhelming Post Splenectomy Infection)

     

What are the indications of Angio Embolization in Splenic Injury?

1.     Extravasation of the contrast during CECT Abdomen

2.     Delayed splenic rupture/ Secondary splenic injury due the Pseudo Aneurysm Bleed.