Delayed hemorrhagic complications in the nonoperative management of blunt splenic trauma

Leeper, W. Robert; Leeper, Terrence; Ouellette, David; Moffat, Bradley; Sivakumaran, Thiru; Charyk-Stewart, Tanya; Kribs, Stewart; Parry, Neil; Gray, Daryl

doi:10.1097/ta.0000000000000228

Cited by 57 publications

(39 citation statements)

References 18 publications

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“…We always have to be careful about preserving organs, especially in young patients, but selective embolization under the status of relatively low blood pressure carries high risks of incomplete embolization because of arterial spasm or unidentified injured arteries, and following delayed events like pseudoaneurysm formation. Describing the timing of delayed splenic events, Leeper et al 9. recently reported their experience of 12 years with the management of hemodynamically stable blunt splenic injuries.…”

Section: Discussionmentioning

confidence: 99%

Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

Uchida

Mizobata

Hagawa

et al. 2018

Acute Medicine & Surgery

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AimBlunt injuries to visceral organs have the potential to lead to delayed pseudoaneurysm formation or organ rupture, but current trauma and surgical guidelines do not recommend repetitive imaging. This study examined the incidence and timing of delayed undesirable events and established advisable timing for follow‐up imaging and appropriate observational admission.MethodsPatients with blunt splenic (S), liver (L), or kidney (K) injury treated with non‐operative management (NOM) in our institution were included and retrospectively reviewed.ResultsFrom January 2013 to January 2017, 57 patients were admitted with documented blunt visceral organ injuries and 22 patients were excluded. Of 35 patients (L, 10; S, 17; K, 6; L & S, 1; S & K, 1) treated with NOM, 14 (L, 4; S, 9; K, 1) patients underwent transcatheter arterial embolization. Delayed undesirable events occurred in four patients: three patients with splenic pseudoaneurysm on hospital day 6–7 and one patient with splenic delayed rupture on hospital day 7. The second follow‐up computed tomography scan carried out 1–2 days after admission did not show any significant findings that could help predict undesirable results of delayed events. The patients with delayed events had longer continuous abdominal pain than that of event‐free patients (P = 0.04).ConclusionsUndesirable delayed events were recognized on follow‐up computed tomography scans in 11.4% of NOM patients at hospital day 6–7 and tended to be associated with high‐grade splenic injuries and continuous symptoms. Repetitive screening of these patients 6–7 days after injury might be warranted because of the potential risk of delayed events.

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Section: Discussionmentioning

confidence: 99%

Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

Uchida

Mizobata

Hagawa

et al. 2018

Acute Medicine & Surgery

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“…[16] Leeper found a 6% rate of SPA and arterial extravasation in patients routinely re-imaged during a 12-year period, suggested routine re-imaging of patients regardless of the splenic injury grade. [17] Muroya et al then looked at the incidence and the management of 104 patients that had non operative management of blunt splenic trauma and found 16 patients (15%) developed SAP (7 patients grade II and 9 grade III) and commonly occurs between days 1 to 8. Interestingly, half of these patients were observed and spontaneously occluded on follow up CT or angiography.…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of a traumatic splenic artery pseudoaneurysm in an initially normal spleen: Case study and review of literature

Dollie

2018

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Background: Blunt injury of the spleen is common and with the shift towards nonoperative management in haemodynamically stable patients, the delayed development of splenic artery pseudoaneurysms are of great concern. Management traditionally involves angioembolisation with the intent to preserve splenic function; however recent studies suggest that this is not without complication. Case presentation: We present a rare case of delayed splenic pseudoaneurysm arising 6 days post motorbike accident, with initial computerised tomography showing no evidence of splenic injury. The patient was successfully embolised and progressed well without complication. No clear cause was found for his development of splenic injury. Conclusions: Splenic artery pseudoaneurysms are not uncommon and necessitate follow-up imaging after nonoperative management of blunt splenic trauma. Once diagnosed, embolisation versus conservative management can be considered on a case-by-case basis.

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“…The infor- Journal of Trauma and Injury Volume 30, Number 3, September 2017 mation was limited to surgery management or NOM, making it impossible to assess prognostic factors.Despite these limitations, our study's significance is confirmation of the importance of spleen injury grade in blunt trauma of spleen and analysis of definitive factors that affect treatment options. Further study analyzed by the cost effectiveness of treatment options, patient heterogeneity, and post NOM complications like pseudo-aneurysm or delayed hemorrhage is needed [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management

Lee

et al. 2017

Journal of Trauma and Injury

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Delayed hemorrhagic complications in the nonoperative management of blunt splenic trauma

Abstract: Therapeutic study, level III.

Cited by 57 publications

References 18 publications

Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

Delayed presentation of a traumatic splenic artery pseudoaneurysm in an initially normal spleen: Case study and review of literature

Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management

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