Shattered spleen - grade V splenic injury

Case contributed by Dr Ian Bickle

Presentation

Young male overseas worker falls from motorbike, which he is using following consumption of alcohol.

Patient Data

Age: 33
Gender: Male

Abdomen/Pelvis

Modality: CT

The spleen is shattered.  On the dual phase images, active contrast extravastation is evident at the splenic hilum.

Large volume haemoperitoneum.

Left sided renal laceration.

Modality: Annotated image

Annotated images showing the active contrast extravastation from the splenic hilum on both arterial and portal venous phases.

Case Discussion

The spleen is 'shattered' into pieces, with active contrast extravasation at the splenic hilum, which extends across the midline towards the hepatic hilum.

High attenuation fluid in the upper abdomen and pelvis in keeping with haemoperitoneum.

This is the highest grade splenic injury (grade 5 .

The patient proceeded to a emergency splenectomy, which confirmed the above, including 1.5 litres of blood in the peritoneum, and a bleeding vessel at the splenic hilum.

The concomitant left renal laceration managed conservatively.

Life lesson: Motorbikes and alcohol are not sensible friends.

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Case Information

rID: 25533
Case created: 29th Oct 2013
Last edited: 19th Dec 2016
Inclusion in quiz mode: Included

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