Successful nonoperative management of AAST grade IV splenic injury with splenic vein thrombosis without angioembolization: a case report

Abstract

High-grade splenic trauma remains challenging, particularly when associated with vascular complications. We report a man in his 20s who sustained blunt abdominal trauma and was diagnosed on contrast-enhanced computed tomography with an American Association for the Surgery of Trauma grade IV splenic injury, moderate haemoperitoneum, and splenic vein thrombosis without active arterial contrast extravasation. Although initially hypotensive, he stabilized after resuscitation with three units of packed red blood cells and three units of fresh frozen plasma. He was successfully managed nonoperatively with close clinical monitoring, serial haemoglobin assessment, and interval imaging. Follow-up imaging demonstrated reduction of haemoperitoneum and partial recanalization of the splenic vein, with complete radiological resolution at 10 months. This case demonstrates that carefully selected patients with high-grade splenic injury and traumatic splenic vein thrombosis may be managed successfully without angioembolization when haemodynamic stability is achieved and maintained.