Abdominal & pelvic trauma: a free FRCS (Gen Surg) Section 1 question

This is a haemodynamically stable blunt splenic injury with a contained vascular lesion (contrast blush or pseudoaneurysm). Stability makes non-operative management appropriate, but a blush is the strongest predictor that observation alone will fail, so angioembolisation is added to raise the splenic salvage rate. Observation alone or simply repeating the CT leaves a lesion with a high risk of delayed rupture untreated. Laparotomy, whether for splenectomy or splenorrhaphy, is reserved for haemodynamic instability, peritonitis or failed non-operative management, and sacrifices or risks a spleen that can usually be saved. Reference: Coccolini F et al., WSES classification and guidelines for splenic trauma, World J Emerg Surg 2017.