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Compartment syndrome — USMLE Step 3 MCQ

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HardSurgery (Post-operative / Follow-up)Compartment syndromeUSMLE Step 3

After blunt abdominal trauma, a hemodynamically stable 29-year-old has an isolated grade IV splenic laceration, moderate hemoperitoneum, and an intraparenchymal contrast blush. There is no peritonitis, and the trauma center has immediate interventional radiology and operating-room capability. What is the preferred management?

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Correct answer: C — Use monitored nonoperative management with splenic angiography and possible embolization

The best answer is “Use monitored nonoperative management with splenic angiography and possible embolization”. Hemodynamic stability and absence of peritonitis permit nonoperative management regardless of injury grade, but grade IV injury, moderate hemoperitoneum, and a contrast blush identify a patient for whom angiography and embolization should be considered. This requires monitored trauma care and immediate rescue laparotomy capability. Grade alone does not mandate splenectomy, while observation without vascular evaluation underuses the CT risk features.

Reference: EAST Practice Management Guideline: Selective Nonoperative Management of Blunt Splenic Injury: https://www.east.org/education-resources/practice-management-guidelines/details/splenic-injury-blunt-selective-nonoperative-management-of