A 68-year-old man fell a distance of 4 feet, landing on his left side. He presented to the emergency room with a blood pressure of 70/40, conscious and in moderate discomfort. Blood was sent for type and cross for 4 units. His blood pressure returned to normal with crystalloid resuscitation and he underwent CT scan while his pressure was stable. The CT scan shows a grade IV (see splenic injury discussion) splenic injury.
The fracture extended into the hilum and the spleen was fragmented into multiple pieces. There was a large subcapsular hematoma as well as significant free fluid in the abdomen. There was also a fracture of the left 7th rib with a small pneumothorax.
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