| Abstract: | The diagnosis of splenic injury after blunt trauma, although clear in most instances, is difficult to make in 16 per cent of our patients.We selected sixty patients who sustained blunt trauma between January 1968 and December 1971 from a large group of patients with multiple system injuries on the basis of isolated splenic injury. Fifty of these patients were evaluated by the usual clinical methods and had splenectomy on the day of admission. Reliable diagnostic criteria are abdominal pain, tenderness localized to the left upper abdomen, fractures of the ninth, tenth, eleventh, and twelfth ribs posteriorly on the left, and evidence of hypovolemia.Ten other patients had initial clinical assessment that cast doubt on the diagnosis of splenic rupture. The splenic artery was selectively catheterized in this group of patients and an arteriogram obtained. Eight arteriograms were positive for splenic trauma. At surgery these arteriographic findings correlated with the splenic disorder in all instances. Two patients had normal arteriograms and were not subjected to surgery.When clinical evaluation precipitates reasonable doubt in the diagnosis of splenic trauma, selective splenic arteriography is an added dimension with marked reliability. |
