TY  - CHAP
M1  - Book, Section
TI  - Spleen
A1  - Shoultz, Thomas H.
A1  - Minei, Joseph P.
A2  - Feliciano, David V.
A2  - Mattox, Kenneth L.
A2  - Moore, Ernest E.
PY  - 2020
T2  - Trauma, 9e
AB  - KEY  POINTSA  high  suspicion  for  splenic  injury  should  exist  when  patients  present  with  signs  or  symptoms  of  trauma  to  the  left  upper  quadrant  or  thoracoabdominal  region.In  hemodynamically  stable  patients,  dual-phase,  multidetector  computed  tomography  scan  of  the  abdomen  with  intravenous  contrast  allows  grading  of  splenic  injuries  and  aids  in  clinical  decision  making.The  revised  Organ  Injury  Scale  from  the  American  Association  for  the  Surgery  of  Trauma  incorporates  vascular  injury  and  active  bleeding  as  grade  IV  and  grade  V  injuries.For  patients  with  splenic  vascular  injury  or  active  bleeding,  angiography  and  embolization  can  significantly  increase  the  success  rate  of  nonoperative  management  over  observation  alone.If  nonoperative  management  for  splenic  injury  is  undertaken,  serial  physical  exams  are  imperative  for  avoiding  missed  injuries  to  the  hollow  viscera.For  patients  requiring  surgical  intervention,  mobilization  of  the  body  and  tail  of  the  pancreas  with  the  splenic  hilum  allows  full  mobilization  of  the  spleen  for  examination  and  appropriate  surgical  treatment.The  incidence  of  overwhelming  postsplenectomy  infection  is  exceptionally  rare,  but  vaccination  in  the  postoperative  period  remains  the  current  standard  of  care.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/25
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1175138310
ER  -