Complete Laparoscopic Management of Isolated Grade 5 Splenic Injury; An Era Or Error.

Oluwamayowa Familua, MD, MRCS, FICS, Morris Franklin, MD, FACS

Texas Endosurgery Institute, San antonio, Texas

Laparoscopic splenectomy has not been well described in patients with major splenic trauma. Uncertainty exists about its efficacy for patients with major polytrauma, a high Injury Severity Score, a high grade splenic injury and significant hemoperitoneum. In these cases, laparoscopic approach could allow full abdominal cavity investigation, hemoperitoneum evacuation with autotransfusion, and spleen removal or repair with readiness to convert to an open operation if vascular control cannot be expeditiously obtained.

We report a case of emergency laparoscopic splenectomy performed in a patient who sustained a blunt abdominal trauma, with isolated grade V splenic injury. After diagnostic laparoscopy, which revealed the presence of large hemoperitoneum and significant splenic parenchyma and hilar laceration, laparoscopic splenectomy was performed. Patient was discharged home 7 days post operatively after managing his associated pulmonary comorbidities. This case shows that laparoscopic splenectomy for isolated splenic trauma irrespective of the grade is feasible and a safe procedure which requires adequate experience in laparoscopic surgery of spleen, competent anesthesiologist and alert operative team.

Figure 1

Figure 2
Figures 1 and 2. Hemoperitoneum from splenic trauma

Surgical reason commonly advocated for preferring the open approach in the face of trauma is related to the need of bleeding control and the skill required laparoscopically. To reduce the operative time to reach hemostasis, we focused on splenic hilar exposure as our initial step after suctioning clots and hemoperitoneum.

Laparoscopy, in our view, is an advantageous procedure in blunt trauma with high grade splenic injury that allows a skilled surgeon to perform the most advantageous treatment with the least surgical morbidity. When emergency splenectomy is necessary it can be quickly and safely performed in experienced hands with significantly better postoperative outcome.

Session: Poster Presentation

Program Number: P661

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