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Blunt abdominal trauma may be present in MVA (occupant and pedestrian), falls, blows, and domestic abuse, and MVAs comprise 80% of abdominal injuries presenting to the emergency room (Ferrera et al., 1998). When blunt force is exerted on the anterior abdominal wall, the viscera are compressed against the vertebral column or the posterior thoracic cage, resulting in crushed tissues and/or organs. Solid organs (e.g., liver, spleen) often are lacerated or fractured by this mechanism of injury. There also are reports of delayed spleen rupture (Ferrera et al., 1998). Sudden deceleration (i.e., MVA with restrained occupant) produces shear force that may result in solid and hollow organ laceration (Ferrera et al. 1998; Stassen et al., 2012). Splenic injury is often associated with left-sided abdominal, flank, and chest injuries/blunt force trauma. Findings indicative of splenic injury with sonography/ultrasound include free intraperitoneal fluid (Ferrera et al., 1998; Stassen et al., 2012). The American Association for the Surgery of Trauma Organ Injury Scale is a criterion for hematoma, and laceration for splenic injuries based on CT findings are presented in Table 17-5(Tinkoff et al., 2008).

Table 17-3 Mechanism of Injury

Several conditions warrant surgical removal of an injured spleen, including either:

• Patient hemodynamically unstable
• > Grade III splenic injury
• Traumatic brain injury (inability to cooperate for imaging studies to evaluate internal hemorrhaging)
• Active peritonitis
• Portal hypertension
• Refusal to receive blood products
• Any other intra-abdominal injuries requiring surgical intervention (Berg et al., 2014; Lo, Matheson, & Adams, 2004)

If a patient does not meet above criteria, then non-operative management, such as observation and/or angiography embolization, may be warranted (Wahl et al., 2004).

Table 17-4 CVP and Differentiation of Shock States

Table 17-5 American Association for the Surgery of Trauma Organ Injury Scale