Laparoscopic Splenectomy Following Embolization for Blunt Trauma

BACKGROUND: Grade III through V splenic injuries as defined by the American Association for the Surgery of Trauma (AAST) grading scale are associated with hemorrhage and nonoperative failure. Embolization has been reported to reduce splenic bleeding in 50% to 75% of patients with a high-grade injury. However, splenectomy following embolization may be necessary in patients who continue to bleed or develop splenic infarction with abscess formation. METHODS: We present the case of a 15-year-old female who demonstrated a Grade V splenic laceration with moderate hemoperitoneum following an all terrain vehicle crash. Central splenic artery embolization was performed. Because of signs of continued bleeding, laparoscopic splenectomy was performed. RESULTS: The patient had a satisfactory postoperative result and returned to normal activity in 2 weeks. CONCLUSION: Our experience suggests that in cases of high-grade splenic injury or angiographic extravasation associated with moderate to large hemoperitoneum, embolization may serve as a bridge to operative therapy and make laparoscopy a safe, less-invasive option for splenectomy.