Current strategies for the management of blunt splenic injuries: A review of nonoperative, operative, and endovascular treatment modalities.

Vollständiger Abstract

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Introduction: The spleen is particularly vulnerable due to its fragile capsule and rich blood supply, making it the second most commonly injured solid organ. Moreover, because of its immune role and development of minimally invasive surgery procedures, management of blunt splenic injuries (BSI) has evolved from routine splenectomy towards individualized strategy comprising three main modalities: surgery (open or laparoscopic), endovascular embolization (SAE) and nonoperative management (NOM).Aim: This paper aims to summarize the current state of knowledge and the experiences of different medical centers on this subject, with a focus on areas that remain unclear and require further investigation.Materials and methods: This literature review included studies from PubMed and Google Scholar published from 2020 to 2025, focusing on the treatment of blunt splenic injuries. The keywords used included: blunt splenic injury, splenic trauma, non-operative management, splenic artery embolization, splenectomy, laparoscopic splenectomy and spleen vaccination.Results: NOM is considered the preferred approach in the treatment of patients with BSI. It is especially recommended for hemodynamically stable patients with low-grade splenic injuries. SAE is commonly used in stable patients with moderate- to high-grade injuries, whereas its effectiveness in unstable patients remains inconsistent compared with operative management. Splenectomy continues to be mainly reserved for hemodynamically unstable patients, especially those with high-grade splenic damage.Conclusions: The initial clinical assessment of patients with BSI plays a crucial role in guiding further management. Hemodynamic stability is the primary factor influencing treatment decisions. Importantly, existing management approaches for BSI demonstrate inconsistencies in clinical practice, highlighting the need for well-defined and standardized criteria.