In a hemodynamically unstable patient with splenic injury, what is the preferred initial management?

In a hemodynamically unstable patient with splenic injury, what is the preferred initial management?

• A. Angiographic embolization of the spleen
• B. Nonoperative management with observation
• C. Laparoscopic splenectomy
• D. Emergent exploratory laparotomy with splenectomy or splenorrhaphy as needed

Answer: (D)

In a hemodynamically unstable patient, the priority is rapid control of bleeding. Nonoperative approaches, including observation or angiographic embolization, require the patient to be stable enough to tolerate time and procedures, which is not the case here. An emergent exploratory laparotomy allows immediate assessment and control of intra-abdominal bleeding. Depending on the injury, the surgeon can perform a splenectomy to stop the hemorrhage or attempt splenorrhaphy if feasible to preserve splenic tissue. Laparoscopic approaches are too slow and not suitable for unstable patients who need quick access and rapid hemostasis. Therefore, urgent open surgery with splenectomy or splenorrhaphy as needed is the appropriate initial management.

In a hemodynamically unstable patient, the priority is rapid control of bleeding. Nonoperative approaches, including observation or angiographic embolization, require the patient to be stable enough to tolerate time and procedures, which is not the case here. An emergent exploratory laparotomy allows immediate assessment and control of intra-abdominal bleeding. Depending on the injury, the surgeon can perform a splenectomy to stop the hemorrhage or attempt splenorrhaphy if feasible to preserve splenic tissue. Laparoscopic approaches are too slow and not suitable for unstable patients who need quick access and rapid hemostasis. Therefore, urgent open surgery with splenectomy or splenorrhaphy as needed is the appropriate initial management.