What is the recommended intervention for splenic rupture in an unstable patient?

In the case of splenic rupture in an unstable patient, the recommended intervention is an exploratory laparotomy (ex-lap) because this surgical approach allows for immediate evaluation and management of internal bleeding, which is critical in unstable patients who may have significant hemorrhage. When a patient presents with signs of splenic rupture and unstable hemodynamics—such as hypotension, tachycardia, or altered mental status—it indicates a potential life-threatening situation where rapid intervention is necessary.

An exploratory laparotomy provides direct access to the abdomen, allowing the surgeon to identify the bleed, assess the extent of damage, and take appropriate steps, whether that involves splenectomy (removal of the spleen) or other necessary procedures to control bleeding and stabilize the patient. This timely surgical intervention can be life-saving, as it addresses the source of hemorrhage and prevents further complications from delayed intervention.

In contrast, imaging studies such as CT scans or ultrasound are generally used to evaluate stable patients or for diagnostic purposes. However, in the context of instability due to suspected splenic rupture, these imaging modalities can delay necessary surgical intervention and put the patient at greater risk. Observation is not appropriate in an unstable patient since immediate action is required to prevent deterioration.