Teaching Case

Abdominal pain and anemia after trauma

A 42 year old male involved in a car accident presented with abdominal pain and acute decrease of red bloood cells (3.900.000). Abdominal ultrasonography showed an inhomogeneity of the spleen. Diastolic and systolic blood pressures were normal and abdominal CT was performed confirming the presence of a splenic traumatic lesion.

The spleen is the intraabdominal organ mostly injuried in case of blunt abdominal trauma and the recognition of the fundamental role of the spleen in the immune response has led to greater efforts to preserve the spleen after injury. Currently two criteria guide the decision to abstain from surgery: hemodynamic stability and absence of another intraabdominal lesions requiring laparotomy. The decision of a conservative management implies a very rigorous clinical monitoring and diagnostic imaging represents a very helpfull tool to establish diagnosis and prognosis. Although ultrasound can be used as an initial effective screening method for blunt abdominal trauma, CT is actually considered the modality of choice for detecting intra-abdominal lesions for stable patients. Enhanced CT prevents the missing of small splenic lesions. Abdominal CT shows the presence and the location of the traumatic lesion, ( subcapsular hematoma, intraparenchymal rupture, capsular disruption, injury extended to hilum), and coexisting abdominal or extraabdominal injuries; it can also depict signs predictive of recurrent bleeding and the so called contrast blush that is considered predictive for te outcome of the non-operative management.