Splenic injury after athletic trauma: a case report of splenic rupture induced by a lacrosse ball

Return to play after liver and spleen trauma

CONTEXT

Sport-related spleen and liver injuries pose a challenge for the physician. Although rare, these injuries can have serious and even life-threatening outcomes if not accurately diagnosed and managed in a timely fashion. Currently, there are no evidence-based guidelines on duration and intensity of restricted activity and return to play after spleen and liver injury. In addition, there is controversy on follow-up imaging after injury.

EVIDENCE ACQUISITION

PubMed was searched using the terms splenic or spleen and trauma and hepatic or liver and trauma from 1980 to 2013. The citations from sentinel papers were also reviewed.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 3.

RESULTS

Ultrasound is ideal in the unstable athlete. Nonoperative management of blunt splenic and hepatic injuries is recommended for hemodynamically stable patients regardless of injury grade, patient age, or presence of associated injuries. Follow-up imaging is not routinely recommended unless clinically indicated. Athletes may engage in light activity for the first 3 months after injury and then gradual return to unrestricted activity as tolerated. High-level athletes may choose splenectomy or serial imaging for faster return to play.

CONCLUSION

Intravenous contrast-enhanced computed tomography is the diagnostic imaging modality of choice in stable athletes with blunt abdominal trauma.

STRENGTH-OF-RECOMMENDATION TAXONOMY

C.

Radiographic evaluation of the patient with sport-related abdominal trauma

Abdominal injuries are rare in sports, but they can be very serious, even life threatening when they occur. With the increasing popularity of snowboarding and extreme skiing, the rate of abdominal injuries is beginning to rise slightly. It is imperative that physicians be able to recognize signs of injury to the liver, spleen, kidney, and hollow abdominal viscera and order appropriate diagnostic tests to investigate these injuries. This article focuses on the imaging modalities physicians can use to assist in diagnosis of sport-related abdominal trauma. Although the sports medicine physician will likely not provide definitive care and treatment of these injuries, because a team approach works best, it is important to know how to diagnose them through the proper studies.