Laparoscopic Splenectomy in a Blunt Trauma Case

Danila Gomes, MD

Product Details
Product ID: ACS-6188
Year Produced: 2020
Length: 11 min.


A 34 y/o male suffered a motorcycle fall and was hit by another vehicle. Conscious at scene and hemodynamically stable, arrival at our service with patent airwaysat 98% in nasal prongs, HR 76, BP 112x80, painful abdomen, unstable pelvis stabilized with a pelvic binder, positive FAST in the hepatorrenal window and urethrorrhagia. GSC 15, isochoric pupils. He presented a transient hemodynamic instability and received 2 units of pRBCs. He remains hemodynamically stable after that and was referred to a CT scan wich found a splenic trauma (spray-type lesion of the spleen), unstable comminuted fracture of the pelvis and also signs suggestives of an injury to posterior urethra. Patient remained stable hemodynamically and an exploratory laparoscopy was indicated. We founded a moderate amount of free blood (aspirated with Cell Saver), splenic lesion with active bleeding in the upper pole of the spleen, absence of liver injury, hematoma in zone III, absence of intraperitoneal bowel or bladder injury. We performed a splenectomy. 798 cc of blood was reinfused with the Cell Saver. Retrograde urethrography identified a complete lesion of the posterior urethra and US-guided percutaneous cystostomy was performed. Orthopaedics team opted for plan a interval internal fixation. Oral diet was reintroduction on the POD2, internal pelvic fixation on the POD7. Hospital discharge on the POD15 and now, patient is in out follow-up. We concluded that there are few cases of laparoscopic splenectomy in trauma cases described in the literature and in well-selected cases, we can consider treatment by laparoscopy.