Non-operative management in blunt splenic trauma

Notash, Ali Yaghoubi; Amoli, Hadi Ahmadi; Nikandish, A; Kenari, Adel Yazdankhah; Jahangiri, Fariba; Khashayar, Patricia

doi:10.1136/emj.2007.054684

Cited by 19 publications

(16 citation statements)

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“…The increased understanding of splenic function in immunological process and identification of post-splenectomy complications have led physicians to prefer the non-operative management (NOM) [4]. There is increasing evidence of the success of the NOM approach in adult BSI patients with hemodynamic stability [5,6]. Currently, NOM has high success rates in pediatric (≥95%) and adult (≥80%) BSI cases, as supported by the management guidelines of the Eastern Association for the Surgery of Trauma (EAST) [7,8].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

et al. 2017

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BackgroundSplenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution.Material/MethodsA retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients.ResultsA total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I–III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury.ConclusionsMost BSI patients had grade I–III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for appropriate management of BSI.

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Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

et al. 2017

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“…The morbidity and mortality associated with BAT results from bleeding due to the disruption of solid organs, vascular structures, and infection from the perforation of hollow viscus [2]. The management of patients with BAT has evolved over the past two decades, with increasing reliance on a non-operative approach and this has become the standard of care [3,7,8]. Sonography is now considered as the screening modality of choice, as it has the ability to demonstrate the amount of intraperitoneal hemoperitoneum within minutes of the patient's arrival [9,10].…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of Blunt Abdominal Trauma at the University of Calabar Teaching Hospital, Nigeria

et al. 2009

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“…The NOM of splenic trauma has gained increasing acceptance in adults recently [8]. The benefits of NOM of splenic trauma include the followings: preservation of splenic function, avoidance of overwhelming post-splenectomy sepsis, avoidance of potential postsplenectomy thrombocytosis and avoidance of the risks associated with nontherapeutic laparotomy [9].…”

Section: Discussionmentioning

confidence: 99%

Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

et al. 2015

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Non-operative management in blunt splenic trauma

Abstract: The decision to pursue non-operative management rather than splenic preservation or splenectomy depends on the individual merits of each case. There is an increasing trend towards splenic preservation, particularly in younger, stable patients.

Cited by 19 publications

References 18 publications

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

A Prospective Study of Blunt Abdominal Trauma at the University of Calabar Teaching Hospital, Nigeria

Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

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