SU28.11 | Splenic Injury and Postsplenectomy Sepsis Prophylaxis — Summary & Reflection

KEY TAKEAWAYS

The spleen lies under the left 9th–11th ribs and is the commonest organ injured in blunt abdominal trauma; injury presents with left upper quadrant pain, Kehr's sign and haemorrhagic shock. Severity is graded by the AAST scale (I–V), assessed by FAST in the unstable patient and CT in the stable one, but management is led by haemodynamic stability: stable patients are managed non-operatively (with angioembolisation for active bleeding), unstable patients undergo operation, with spleen-conserving surgery preferred and splenectomy for grade V or persistent instability. Because the spleen clears encapsulated bacteria, asplenia risks overwhelming post-splenectomy infection (OPSI) from Streptococcus pneumoniae, Haemophilus influenzae type b and Neisseria meningitidis. Prophylaxis is: vaccination (pneumococcal, Hib, meningococcal — ideally ≥2 weeks before elective splenectomy, or after recovery if emergency), prophylactic penicillin, and patient education with a medic-alert card and early treatment of any fever.

REFLECT

Return to the injured motorcyclist in the hook. If he stabilises with resuscitation and his CT shows a grade III splenic injury with no contrast blush, what is your management, and what would change your plan over the next 24 hours? Now imagine his injury was grade V and he remained unstable, so his spleen was removed. Write the discharge plan you would give him — the vaccines and their timing, the antibiotic, and the single instruction about fever that he must never forget. How does this plan protect him for the rest of his life?