Splenic Trauma: Rethinking the Classic Approach Through Interventional Radiology

Introduction: Blunt splenic injury is a common clinical challenge in polytrauma, with the majority resulting from road traffic accidents or falls. Treated traditionally by splenectomy, treatment guidelines have increasingly shifted towards spleen-preserving methods. Non-operative management, with hemodynamic control and serial imaging as benchmarks, has consistently demonstrated superior rates of success, particularly for low-grade injuries, attesting to its effectiveness. Materials and Methods: This was a retrospective study involving the review of patient records, imaging studies, and surgical reports on splenic injury management over the last five years (2019–2024) at an Albanian tertiary-level trauma center. We compared outcomes for operative and non-operative management and concluded on the potential role of interventional radiology (IR) in the treatment of severe splenic injuries. Results: Patients between the ages of 6 and 85 years (mean age 39.2 ± 20.6 years) were enrolled in the study. The non-operative management approach was utilized in 50.6% of patients, and operative management was separated into two subgroups: immediate surgery in 22.9%, and delayed surgery in 26.5%. The overall mortality was 10.8%, and the observed survival was 89.2%. Conclusion: Non-operative management remains the standard for the treatment of low-grade splenic trauma. However, in more critical trauma, interventional radiology provides a minimally invasive, spleen-preserving solution that fills the gap between observation and surgery. The role of interventional radiology in managing splenic injuries in the future is not merely promising, but a source of hope and optimism. The establishment of IR services within trauma centers is a clinically sound and cost-saving option that can optimize outcomes and enhance resource utilization.