Minimally invasive splenectomy in grade IV splenic trauma: A case report associated with high-grade renal trauma

•The laparoscopic approach in abdominal trauma is being increasingly accepted due to its advantages over conventional surgery.•Laparoscopic splenectomy can be successfully applied in hemodynamically patients with moderate splenic trauma.•Appropriate patient selection is necessary for combined management of laparoscopic and conservative treatment.•Experienced team in trauma surgery and advanced laparoscopic surgery are required for laparoscopic splenectomy in trauma. In closed abdominal trauma, the spleen is the most frequently injured organ (30–45%). Splenic lesions grades IV-V have higher failure rates with nonoperative management (NOM). The minimally invasive approach is an alternative when NOM fails. This is the first reported case of a patient with splenic and left renal trauma, both grade IV, with combined management, which consisted of a minimally invasive surgical resolution of the splenic trauma and a conservative management of the renal trauma, with a satisfactory recovery of the patient. This contributes to understanding the benefits of minimally invasive surgery in moderate splenic trauma associated with other high-grade injuries. We present a 45-year-old woman with a multiple trauma after a motorbike vs car traffic accident. On physical examination, she was hemodynamically stable, with abdominal guarding and generalized rebound tenderness associated with multiple upper and lower limb fractures. An abdominal CT scan revealed grade IV splenic and left renal trauma, with moderate hemoperitoneum. A minimally invasive laparoscopic approach for hemoperitoneum drainage and splenectomy was performed. There is currently no consensus to define the indications for minimally invasive treatment on splenic trauma. While laparotomy is the standard treatment, it is not without potential severe complications, while laparoscopy providing a treatment option in selected cases with hemodynamic stability. The role of the minimally invasive approach is safe and feasible in selected patients with high-grade splenic lesions and hemodynamic stability, including the association with other organic lesions such as kidney trauma.