Table 1.

Indications for splenectomy in hemodynamically stable trauma

High–moderate grade (AAST grade II and above) splenic injury and clinical or radiological findings suggestive of a possible traumatic hollow viscus injury, diaphragmatic injury or other abdominal source of hemorrhage not amenable by AE (e.g., mesenteric injury)

High–moderate grade (AAST grade II and above) splenic injury with blush in penetrating trauma

High–moderate grade (AAST grade II and above) splenic injury with subcapsular hematoma

High–moderate grade (AAST grade II and above) splenic injury (with or without blush) and NOM ± AE contraindicated (e.g., pregnant, mentally impaired, homeless, severe allergy to intravenous iodine contrast, kidney failure)

High–moderate grade (AAST grade II and above) splenic injury (with or without blush) and NOM ± AE refused by patient (e.g., self-employed, professional athletes)

High–moderate grade (AAST grade II and above) splenic injury with blush and NOM with AE technically not feasible (e.g., tortuous splenic artery, celiac trunk stenosis, failure in releasing the coils)

High–moderate grade (AAST grade II and above) splenic injury (with or without blush) and NOM ± AE failed (e.g., persistent blush or persistent venous oozing, pseudoaneurisms, delayed-rupture, splenic abscess)

High–moderate grade (AAST grade II and above) splenic injury with blush NOM and AE unavailable

Splenic injury without blush and with significant haemoglobin drop due to persistent venous oozing

High-grade (AAST grade III and above) splenic injury (with or without blush) and need of urgent complex orthopaedic surgery (especially if in prone position, e.g., spinal and pelvic surgery)

High–moderate grade (AAST grade II and above) splenic injury in pathologic splenomegaly (e.g., lymphoma, tropical, autoimmunity, portal hypertension)