## Most Common Organ Injured in Blunt Abdominal Trauma **Key Point:** The spleen is the most frequently injured solid organ in blunt abdominal trauma, accounting for approximately 40–50% of all blunt splenic injuries in trauma patients. ### Anatomical Vulnerability - The spleen is highly vascular and friable, with a thin capsule that ruptures easily on impact. - Located in the left upper quadrant (LUQ), protected only by the left rib cage (ribs 9–11). - Rib fractures in the left lower chest are a strong predictor of splenic injury. ### Clinical Presentation - Kehr sign: left shoulder pain due to diaphragmatic irritation from splenic bleeding. - Free fluid on FAST in the left paracolic gutter or perisplenic space. - Haemodynamic instability if bleeding is brisk. ### Mechanism of Injury - Blunt force to the left flank or lower left chest causes direct laceration or crush injury. - Deceleration injuries (e.g., MVC, fall from height) can cause splenic avulsion. ### Management Approach ```mermaid flowchart TD A[Splenic injury confirmed]:::outcome --> B{Haemodynamically stable?}:::decision B -->|Yes| C[Non-operative management]:::action C --> D[ICU/HDU monitoring] C --> E[Serial abdominal exams] C --> F[Cross-matched blood available] B -->|No| G[Splenectomy]:::action G --> H[Vaccinate post-op]:::action ``` **High-Yield:** Over 90% of haemodynamically stable splenic injuries can be managed non-operatively with bed rest, serial clinical assessment, and ICU/HDU monitoring. Splenectomy is reserved for haemodynamic instability or peritonitis. [cite:ATLS 10th Edition Ch 7] **Clinical Pearl:** Post-splenectomy patients require vaccination against *Streptococcus pneumoniae*, *Neisseria meningitidis*, and *Haemophilus influenzae* type b to prevent overwhelming post-splenectomy infection (OPSI).
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