Penetrating Injuries to the Spleen and Kidney: an Evolution in Progress

Abstract

Optimal management of penetrating abdominal trauma, especially for kidney and splenic injuries, is evolving. Opinions range from aggressive surgical exploration to expectant management. This report addresses the recent advancements in the diagnosis, grading, and management of penetrating injuries to the kidney and spleen. A special focus is provided on the shifting paradigm towards non-operative management. Penetrating renal trauma management has evolved significantly over the past few years. Advancements in diagnostic tools and evolution of injury grading have paved the way for selective non-operative management. Penetrating injuries to the spleen provide a unique management challenge. With the evolution of non-operative management, appropriate patient selection is mandatory. Optimal use of computed tomography scanning and angiography can improve the organ salvage rates; however, hemorrhage control is still the main goal.

The Evolution of Nonoperative Management of Abdominal Gunshot Wounds in the United States

“…In terms of injury parameters, 49% of the population presented with a solid organ injury, and 61% presented with a bowel injury. The overall median ISS was 18 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and the median abdomendAIS was 3 (1-4). Most patients were transferred to level I ACS-verified trauma center (59%) ( Table 1).…”

“…9,11,12 This high rate of negative exploration and its associated morbidity encouraged a more selective approach in the management of patients presenting with penetrating abdominal trauma. 13 Although the selection of the ideal patient presenting with an abdominal gunshot wound (AGW) for nonoperative management (NOM) remains challenging, 14 the utilization of NOM in a select group of patients with penetrating abdominal trauma has proved to be successful. [15][16][17] The safety of NOM for AGWs has been suggested in the literature [18][19][20] ; however, there is paucity of data regarding the degree of its utilization and its effects on outcomes.…”

The Role of Dual-Energy CT in Solid Organ Injury

“…The spleen is among the commonest injured organs in blunt abdominal trauma, accounting for up to 49% of all visceral injuries. 39,40 Splenectomy was the traditional treatment of splenic injury for around 100 years. 36 King and Schumacher's description of post-splenectomy lethal sepsis in 1952 shed light on the immunological role of the spleen in preventing septicemia 41 paving the way for NOM of splenic injuries.…”

Pattern and Outcome of Splenic Injury in Children

“…The mechanisms of splenic trauma include: falling from a height, bicycle injuries, child abuse, sports-related injuries, and motor vehicle and pedestrian injuries (2). Traumatic injury to the spleen can be blunt or penetrating with the former being more common than the latter (3). In comparison to adults, children have an elastic rib cage which causes transmission of force into the abdominal compartment (4).…”