الفهرس 
Anatomy of the spleenOnly 14 pages are availabe for public view
 |  | from | 168 |  |  |
| | | from | 168 | | |
Abstract
Blunt abdominal trauma is more frequently encountered in the emergency department than penetrating one , usually result from motor vehicle collision (Hoyt D.B et al., 2001). Blunt trauma to the abdomen can cause severe injury especially to solid abdominal organs (Hann et al., 2005). The liver and the spleen are the most frequently injured organs, small and large intestines are the next most injured organs (Salomone et al.,2001).
Clinical presentation of splenic injuries:
1- fatal type:
Hemorrhage is so massive that the patient is severely shocked with rapid death occurring before any surgical intervention.
2- classical type : the commonest presentation.
general manifestations of internal hemorrhage with increase pallor, rapid weak pulse , law blood pressure and air hunger due to o2 lack.
• Abdominal examination show tenderness and rigidity in the left hypochondrium.
• Special signs may be present:
• Balance’s sign: shifting dullness on the right side and fixed dullness on the left side.
• Kehr’s sign: referred pain to the left shoulder.
• Cullen’s sign: Brownish or bluish discoloration around the umbilicus.
3- Delayed type : initial shock followed by along lucid interval which may be few days or weeks. The patient presents with the picture of internal hemorrhage this delay may be due to:
• The formation of subcapsular haematoma which may rupture later.
• The greater omentum seals the region of the spleen from the peritoneal cavity and then retracts releasing blood.
• Aclot may form to block the tear and stop bleeding and later dislodged when the blood pressure rises or digested by enzymes from the injured pancreas. (Andrew B. Peitzman et al ., 2002 ).
Radiological grades of splenic injuries.
Grade I Subcapsular Haematoma <10% surface area Laceration <1cm depth.
Grade II Subcapsular Haematoma 10% to 50% surface area; intra parenchymal, <5cm in diameter.
Laceration, 1-3cm parenchymal depth that does not involve a trabecular vessel
Grade III Subcapsular, Haematoma >50% surface area or expanding; ruptured subcapsular or parenchymal haematoma; intraparenchymal haematoma ≥ 5cm or expanding.
Laceration >3cm depth or involving trabecular vessels
Grade IV Laceration involving segmental or hilar vessels producing major devascularization (>25% of spleen)
Grade V Completely shattered spleen or Hilar vascular injury that devascularizes spleen.
(Moore et al., 1995)
The recognition of the fundamental role of the spleen in the immune response has led to greater efforts to preserve the spleen after injury (Pachter HL , 2000).
Treatment of splenic injury has changed substantially during the modern surgical era .For most of 20th century surgeons , splenectomy was the treatment of choice for all splenic injuries . However , During the last decade , improved imaging methods and demonstrated success of non operative treatment for children have increased the frequency of non -operative management of blunt splenic trauma (Peitzman et al ., 2000).
With modern imaging techniques , most pediatric patients and many adult patients with splenic injuries can be safely managed without laparotomy and their spleens not only stop bleeding but also heal (Knudson and Maull, 1999).
Controversy exists about how to appropriately select patients for non-operative treatment since bleeding from splenic injuries can incur significant morbidity and mortality (Herbrecht BG , 2005).