Management of spleen injuries: the current profile

Mikocka‐Walus, Antonina; Beevor, Harriet C; Gabbe, Belinda; Gruen, Russell L.; Winnett, Jason; Cameron, Peter

doi:10.1111/j.1445-2197.2010.05209.x

Cited by 11 publications

(8 citation statements)

References 16 publications

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“…Total splenectomy 61.7% was the commonest operation performed in our splenic injured patients. In the literature the rate range was 32% -72% [10,12,14,15,20]. Whereas Splenorrhaphy was practiced in 4.3% of our patients and this simulate others' findings [20,21], but lower than 19.2% in a Nigerian study [10].…”

Section: Operative Managementsupporting

confidence: 68%

Traumatic Splenic Injuries in Khartoum, Sudan

Ibrahim¹,

Hamza²,

Ahmed³

2013

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Background: Spleen injuries are most commonly associated with blunt abdominal trauma and represent a potentially life-threatening condition. Objectives: To study the pattern of splenic injuries of the patient, management instituted and its outcome at Khartoum. Patients and Methods: This is a prospective, analytic and hospital-based multicenteric study, conducted at the three main Teaching hospitals at Khartoum. The study was carried over a period from April 2012 to February 2013. It includes all patients, diagnosed as traumatic splenic injury. Excluded were patients with history of splenic disease, iatrogenic injury or spontaneous rupture. Results: The study included 47 patients: their mean age was 26.4 years (SD ± 14.5). Most of them 41 (87.2%) were in the first four decades of life. Males were predominant 41 (87.2%), with a male to female ratio of 6.8:1. The majority of our patients had blunt abdominal trauma 39 (83%), of whom, road traffic accident accounted for 51.1% and none reported cases of gunshot. Isolated splenic injury was found in 23 (48.9%), and Haemodynamic stability was seen in 27 (57.4%) on presentation. The initial haemoglobin assessment revealed <9 gram/dl in 53.2%. CT scan was performed to 24 (51.1%), of whom 66 patients were Grade I and II and none of our patients were diagnosed as Grade V. Blood transfusion was required in 42 (89.4%). Operative treatment was adopted in 66% (61.7% total splenectomy and 4.3% splenorrhaphy), while selective non-operative management was successful in 16 (34%) of the patients. Higher intra-operative grade of splenic injury was found to be significantly associated with blunt abdominal trauma, haemodynamic instability and associated intra-abdominal injuries. 44 patients (93.6%) were discharged home in a general good condition. The morbidity and mortality were seen in 8.5% and 6.4% respectively. Conclusion: Splenic injuries usually follow blunt abdominal trauma, particularly after road traffic accidents. It is common during the first four decades of life with males being frequently affected. The great success rate of adopting selective non-operative management is worthwhile.

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Section: Operative Managementsupporting

confidence: 68%

Traumatic Splenic Injuries in Khartoum, Sudan

Ibrahim¹,

Hamza²,

Ahmed³

2013

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“…While non-operative management of blunt splenic injury is a growing trend, and the use of splenic artery embolisation is commonplace in the literature, the under-utilisation of embolisation has been noted in other Australian tertiary trauma centres. Mikocka-Walus et al (2010) concluded that embolisation was under-utilised in Victorian trauma hospitals where only 17 of 300 patients presenting with blunt splenic injury received embolisation. Mikocka-Walus et al (2010) suggested that a reason for the under-utilisation of embolisation may be that patients with low-grade injuries are managed conservatively while patients with high-grade injuries and/or multiple abdominal injuries proceed to the operating theatre and were more likely to have a splenectomy.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The indication for splenic artery embolisation is influenced by the haemodynamic status of the patient, the presence of contrast extravasation or pseudoaneurysm on CT scan, the severity of the splenic injury, the size of the haemoperitoneum and the patient's age. The complexities in the initial assessment of these patients have led some to comment of the apparent under-utilisation of splenic artery embolisation in some centres (Mikocka-Walus et al., 2010).…”

Section: Introductionmentioning

confidence: 99%

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The management of blunt splenic injury with active bleeding: A review

Diepenhorst

Hatzifotis

Wall

2013

Trauma

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Blunt splenic injuries are a common management problem facing general surgeons. It has been suggested that management of blunt splenic injuries should take into account the presence of active bleeding and the Organ Injury Scale (OIS grade); where active bleeding is more significant with OIS grade IV and V injuries. This paper aims to review our management of blunt splenic injuries with active bleeding in the haemodynamically stable patient. The trauma databases of two tertiary referral centres in Queensland were reviewed for patients admitted with blunt abdominal injuries since 2006. The management of patients with splenic injury and active bleeding was reviewed. A total of 173 patients were admitted after 2006. Twentysix of these patients had active bleeding and nine were treated conservatively. Four patients failed conservative management and required further intervention. Three patients with OIS grades IV or V were managed conservatively and failed this management requiring further intervention. Our results indicate that conservative management is not possible for OIS grades IV and V injuries. Furthermore, splenic artery embolisation augments the success of conservative management and reduces the need for splenectomy. These findings are consistent with the current literature suggesting that management of blunt splenic injury must take into consideration factors other than the Organ Injury Scale.

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“…With increasing recognition of the role of the spleen in immunological function and awareness of overwhelming post-splenectomy infection (OPSI), atherogenesis and ischemic diseases, there has been an increasing trend towards NOM and splenic salvage procedure. [1] However, this policy change towards splenic conservation requires careful risk-benefit analysis in the face of potentially life-threatening hemorrhage from delayed splenic rupture and the possibility of transfusion-induced viral infections. Furthermore, the increasing availability of reliable and good quality radiological imaging, including ultrasound and computerized tomography (CT) scanning, has greatly improved the information available with regard to the nature of the splenic injury, and this may well help to identify the suitable patients for NOM, [2] but at the expense of radiation to the patient.…”

Section: Resultsmentioning

confidence: 99%

Splenic trauma - our experience at a level I Trauma Center

Saurabh

Kumar²,

Gupta³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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AMAÇNon-operatif tedavinin dalak travmalı hastalar üzerindeki etkilerini belirlemek üzere, I. Basamak Travma Merkezimizde Ocak 2007 ile Haziran 2008 tarihleri arasında retrospektif bir çalışma yürütüldü. GEREÇ VE YÖNTEMHasta demografisi, dalak yaralanması biçimi, bilgisayarlı tomografi (BT) evrelemesi, kan transfüzyon gereksinimi, cerrahi bulgular, hastanede kalış ve takip ile ilgili bilgiler toplandı. Splenik yaralanmanın kanıtı olarak ve yaralanmanın evresini belirlemek üzere, karın ultrasonografisi ve BT tarama sonuçları kullanıldı. Hastalar splenektomi ve non-operatif gruplarına ayrıldı. Bulgular non-parametrik Mann-Whitney U testiyle analiz edildi. BULGULARAltmış yedi hasta çalışmaya alındı . Evre I yaralanması olan bütün hastalarla evre II yaralanması bulunan 13 hastanın 12'si non-operatif olarak tedavi edilirken, evre III 16 hastanın 9'u, evre IV 14 hastanın 12'si ve evre V bütün hastalar cerrahi yöntemle tedavi edildi. Bu nedenle, ne kadar yük-sek yaralanma derecesi söz konusu ise o kadar çok operatif tedavi gerçekleşti. Operatif grubun ortalama Yaralanma Şiddet Skoru (20,12), non-operatif grubun Yaralanma Şid-det Skorundan (11,9) anlamlı şekilde daha yüksek bulundu (p=0,001). Operatif ve non-operatif gruplardaki ortalama hastane kalışları, sırasıyla 12,8 ve 8,3 gün idi. SONUÇDalak travmasının non-operatif tedavisi kabul edilebilir sonuçlarla uygulanabilmektedir.Anahtar Sözcükler: Splenik travma; splenektomi; non-operatif tedavi.

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Management of spleen injuries: the current profile

Abstract: In Victoria, conservative management is the preferred approach in patients with minor (AIS = 2) to moderate (AIS = 3) splenic injuries. The low rates of embolization warrant further research into whether splenectomy is overused.

Cited by 11 publications

References 16 publications

Traumatic Splenic Injuries in Khartoum, Sudan

Traumatic Splenic Injuries in Khartoum, Sudan

The management of blunt splenic injury with active bleeding: A review

Splenic trauma - our experience at a level I Trauma Center

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