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Splenic rupture — MCCQE Part 1 MCQ

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ModerateTraumaSplenic ruptureMCCQE Part 1

A 22-year-old hockey player sustains blunt left upper-quadrant trauma. He has left shoulder-tip pain, diffuse tenderness, heart rate 132/min, and blood pressure 78/46 mm Hg despite initial blood-product resuscitation. FAST shows free intraperitoneal fluid. What is the most appropriate next step?

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Correct answer: A — Continue haemorrhage-control resuscitation and transfer immediately for exploratory laparotomy

Option A is best. This patient is a haemodynamic non-responder after blunt abdominal trauma, and the positive FAST identifies intraperitoneal fluid as the likely source of shock. Haemorrhage-control resuscitation should continue while he is transferred immediately to the operating room for exploratory laparotomy and surgical bleeding control. CT is intended for patients who are stable or have stabilized sufficiently for imaging. Non-operative observation and splenic artery embolization are spleen-preserving strategies for selected stable or stabilized patients in appropriately resourced centres, not for persistent shock. The exact intraoperative splenic procedure depends on the injury and response, but further diagnostic delay or outpatient care is unsafe.

Reference: World Society of Emergency Surgery splenic-trauma guideline: https://doi.org/10.1186/s13017-017-0151-4 ; 2022 WSES non-operative follow-up consensus: https://pmc.ncbi.nlm.nih.gov/articles/PMC9560023/