Current Concepts in Splenic Trauma

Dupuy, Damian E.; Raptopoulos, Vassilios; Fink, Mitchell P.

doi:10.1177/088506669501000204

Cited by 9 publications

(4 citation statements)

References 108 publications

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“…Trauma is the first cause of death and a significant cause of morbidity in people younger than 40 years of age in western countries, representing, therefore, a relevant clinical problem [1,2]. The liver and the spleen, despite relatively shielded by the inferior ribs, represent commonly injured organs during abdominal blunt trauma, accounting for about two-thirds of all visceral injuries [3-6]. Until three decades ago, the surgical treatment represented the most common therapeutic strategy for blunt trauma of abdominal parenchymatous organs [7-9].…”

Section: Introductionmentioning

confidence: 99%

Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol

Brillantino¹,

Iacobellis²,

Festa³

et al. 2019

BEAT

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Objective:To evaluate the safety and effectiveness of NOM (non-operative management) in the treatment of blunt liver trauma, following a standardized treatment protocol. Methods:All the hemodynamically stable patients with computed tomography (CT) diagnosis of blunt liver trauma underwent NOM. It included strict clinical and laboratory observation, 48-72h contrast enhanced ultrasonography (CEUS) or CT follow-up, a primary angioembolization in case of admission CT evidence of vascular injuries and a secondary angioembolization in presence of vascular injuries signs at follow-up CEUS. Results:181 patients (85.4%) [55 (30.4%) women and 126 (69.6%) men, median age 39 (range 14–71)] were included. Of these, 63 patients (34.8%) had grade I, 48 patients (26.5%) grade II, 39 patients (21.5%) grade III, 21 patients (11.6%) grade IV and 10 patients (5.5%) grade V liver injuries. The overall success rate of NOM was 96.7% (175/181). There was not significant difference in the success rate between the patients with different liver injuries grade. Morbidity rate was 7.4% (13/175). Major complications (2 bilomas, 1 liver hematoma and 2 liver abscesses) were successfully treated by CEUS or CT guided drainage. Eighteen (18/181) patients (9.9%) underwent angioembolization with successful results. Conclusion: Non-operative management of blunt liver trauma represents a safe and effective treatment for both minor and severe injuries, achieving an high success rate and an acceptable morbidity rate. The angiographic study with embolization, although required only in selected cases of vascular injuries, represents a fundamental therapeutic option in a significant percentage of patients.

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Section: Introductionmentioning

confidence: 99%

Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol

Brillantino¹,

Iacobellis²,

Festa³

et al. 2019

BEAT

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“…[1] Spleen represent the most commonly damaged organ during abdominal blunt trauma and is affected in about 33% of patients with traumatic abdominal injuries. [2–4] Liver is the solid organ with highest injury rate in abdominal injuries, and approximately 15% to 20% of these refer to hepatic trauma. Hepatic injury takes the third place in abdominal injury and 80% to 90% of hepatic injuries are blunt ones.…”

Section: Introductionmentioning

confidence: 99%

The role of grade of injury in non-operative management of blunt hepatic and splenic trauma

Ruscelli

Gemini²,

Rimini

et al. 2019

Medicine

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This retrospective study shows the results of a 2 years application of a clinical pathway concerning the indications to NOM based on the patient's hemodynamic answer instead of on the injury grade of the lesions.We conducted a retrospective study applied on a patient's cohort, admitted in “Azienda Ospedaliero-Universitaria Ospedali Riuniti of Ancona” and in the Digestive and Emergency Surgery Department of the Santa Maria of Terni hospital between September 2015 and December 2017, all affected by blunt abdominal trauma, involving liver, spleen or both of them managed conservatively. Patients were divided into 3 main groups according to their hemodynamic response to a fluid administration: stable (group A), transient responder (group B) and unstable (group C). Management of patients was performed according to specific institutional pathway, and only patients from category A and B were treated conservatively regardless of the injury grade of lesions.From October 2015 to December 2017, a total amount of 111 trauma patients were treated with NOM. Each patient underwent CT scan at his admission. No contrast pooling was found in 50 pts. (45.04%). Contrast pooling was found in 61 patients (54.95%). The NOM overall outcome resulted in success in 107 patients (96.4%). NOM was successful in 100% of cases of liver trauma patients and was successful in 94.7% of splenic trauma patients (72/76). NOM failure occurred in 4 patients (5.3%) treated for spleen injuries. All these patients received splenectomy: in 1 case to treat pseudoaneurysm, (AAST, American Association for the Surgery of Trauma, grade of injury II), in 2 cases because of re-bleeding (AAST grade of injury IV) and in the remaining case was necessary to stop monitoring spleen because the patient should undergo to orthopedic procedure to treat pelvis fracture (AAST grade of injury II).Non-operative management for blunt hepatic and splenic lesions in stable or stabilizable patients seems to be the choice of treatment regardless of the grade of lesions according to the AAST Organ Injury Scale.

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“…The spleen is the most commonly injured organ in blunt abdominal trauma [11,12], and is less commonly injured than other abdominal viscera in penetrating trauma due to its relatively protected position. Blunt splenic injury (BSI) occurs via three mechanisms: shear due to differential acceleration/deceleration, compression by raised intra-abdominal pressure and direct crush against the thoracic cage.…”

Section: Pathophysiologymentioning

confidence: 99%

Management of Splenic Injury

Hancock

Farquharson

2012

J R Army Med Corps

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Traumatic splenic injury is a potentially life-threatening complication of both blunt and penetrating trauma to the abdomen and thorax. The spleen is susceptible to injury in the presence or absence of damage to surrounding viscera and can lead to haemodynamic instability and hypovolaemic shock. This review examines the classification, investigation and management of this condition with both non-operative and operative techniques.

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Current Concepts in Splenic Trauma

Cited by 9 publications

References 108 publications

Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol

Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol

The role of grade of injury in non-operative management of blunt hepatic and splenic trauma

Management of Splenic Injury

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