Solid Organs

Symptoms and signs are normally related to blood loss from injury to these very vascular organs. Signs of shock may be present but will be a late sign in a young, fit patient.

Injury to the liver or spleen are common injuries following blunt trauma and can be identified on a trauma CT scan.

Fig 1 Signs and symptoms of a patient in hypovolaemic shock

Liver

Liver injuries account for 15-20% of intra-abdominal organ injuries but up to 50% of mortality, and 45% have associated splenic injury.

Conservative management is appropriate in 80% of cases, with surgical intervention reserved for ongoing and uncontrolled bleeding.

If hepatic or splenic injuries are detected on CT, the source of any ongoing bleeding can be detected through angiography. Through interventional radiology it can be possible to embolise the bleeding vessel and remove the need for surgical intervention.

Fig 2 CT scan showing laceration to the liver

Spleen

Splenic injury is graded according to CT findings and treatment is guided by grade:

Grade 1	Minor subcapsular tear or haematoma
Grade 2	Parenchymal injury not extending to the hilum
Grade 3	Major parenchymal injury involving vessels and hilum
Grade 4	Shattered spleen

Fig 3 CT scan showing ruptured spleen

Pancreas

• Injury to the pancreas may cause pancreatitis, which may develop over days.
• Blunt pancreatic injury may not be immediately recognised. It is relatively uncommon, occurring in around 10% of blunt abdominal injuries but it is rarely an isolated injury due to the position of the pancreas.
• Amylase elevation will often not occur until 3-4 hours after injury, if at all, and lipase is no more specific for pancreatic trauma.