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An 81-year-old man collapsed at home after complaining of left upper quadrant (LUQ) abdominal pain and presented to the local hospital. He was hypotensive on arrival, but stabilized with transfusion of 2 units of packed red blood cells. His abdominal examination was significant for LUQ tenderness with no signs of peritonitis. Abdominal CT scan (figure 1) revealed splenomegaly with grade 3 splenic injury and moderate hemoperitoneum. Blood work was significant for anemia and elevated creatinine (Cr 1.9 mg/dL). Spontaneous splenic rupture (SRS) was suspected and the patient was transferred to the nearest level 1 trauma center for management.
What would you do?
Non-operative management (NOM).
Emergency splenectomy.
Splenic angioembolization (SAE).
Stabilization and laparoscopic total splenectomy.
What we did and why
Correct answer D
We stabilized the patient and performed a laparoscopic total splenectomy. The patient’s vital signs were normal on arrival, so he was monitored in the intensive care unit with plan for emergency splenectomy if he destabilized. His creatinine and hematocrit normalized, so he underwent laparoscopic hand-assisted splenectomy. Operative findings revealed splenomegaly with hemoperitoneum. The spleen was mobilized from its attachments, the splenic vessels were …