Primary Care of the Blunt Splenic Injured Adult

Yorkgitis, Brian K.

doi:10.1016/j.amjmed.2016.10.010

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…In the last 40 years, the non-operative management has almost completely replaced splenectomy and is now widely accepted as the standard care for low-grade injuries. In our experience, in line with the literature, no patient with an Abbreviated Injury Scale >3 has undergone a conservative management [22-26]. In many published case-series, about 60% of patients with splenic injuries are treated conservatively; this number is higher compared to our study (about 40%), although with a very low rate of failure [27-31].…”

Section: Discussionsupporting

confidence: 87%

Non-operative management of blunt splenic injury: is it really so extensively feasible? a critical appraisal of a single-center experience

Fransvea¹,

Costa²,

Massa³

et al. 2019

Pan Afr Med J

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Introduction The spleen is one of the most commonly injured organ following blunt abdominal trauma. Splenic injuries may occur in isolation or in association with other intra-and extra-abdominal injury. Nonoperative management of blunt injury to the spleen has become routine in children. In adult most minor splenic injuries are readily treated nonoperatively but controversy exists regarding the role of nonoperative management for higher grade injuries above all in multi-trauma patients. The aim of this study is the assessment of splenic trauma treatment, with particular attention to conservative treatment, its limits, its efficiency, and its safety in multi-trauma patient or in a severe trauma patient. Methods The present research focused on a retrospective review of patients with splenic injury. The research was performed by analyzing data of the trauma registry of St. Andrea University Hospital in Rome. The St. Andrea University Hospital trauma registry includes 1859. The variables taken into account were spleen injury and general injuries, age, sex, cause and dynamic of trauma, hemoglobin, hematocrit, white blood cells count, INR, number and time blood transfusion, hemodynamic stability, type of treatment provided, hospitalization period, morbidity and mortality. Assessment of splenic injuries was evaluated according to Abbreviated Injury Scale (AIS). Results The analysis among the general population of spleen trauma patients identified 68 patients with a splenic injury representing the 41.2% of all abdomen injury. The Average age was of 37.01 ± 17.18 years. The Average ISS value was of 22.88 ± 12.85; mediana of 24.50 (range 4-66). The average Spleen AIS value was of 3.13 ± 0.88; mediana 3.00 (range 2-5). The overall mortality ratio was of 19.1% (13 patients). The average ISS value in patients who died was of 41.92 ± 12.48, whereas in patients who survided was of 23.33 ± 10.15. The difference was considered to be statistically significant (p <0.001). The relashionship between the ISS and AIS values in patients who died was considered directly proportional but not statistically significant (Pearson test AIS/ISS = 0.132, p = n.s.). The initial management was a conservative treatment in 27 patients (39.7%) of them 4 patients (15%) failed, in the other 41 cases urgent splenectomies were performed. The average spleen AIS in all the patients who underwent splenectomy was 3.61 ± 0.63 whereas in the patients who were not treated surgically was 2.42 ± 0.69. The difference was deemed statistically significant (p <0.001). Conclusion Splenic injury, as reported in our statistic as well as in literature, is the most common injury in closed abdominal trauma. Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The preference of a conservative treatment must be based on the hemodynamic stability indi...

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Section: Discussionsupporting

confidence: 87%

Non-operative management of blunt splenic injury: is it really so extensively feasible? a critical appraisal of a single-center experience

Fransvea¹,

Costa²,

Massa³

et al. 2019

Pan Afr Med J

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“…As such the role of splenectomy, especially in trauma, has been re-evaluated. Although preservation is recommended in over 90% of splenic trauma, splenectomy is still an indicated procedure for haematological, malignant and non-malignant causes [2,3] .…”

Section: Introductionmentioning

confidence: 99%

Splenic autotransplantation: a systematic review

Surendran

Smith

Houli

et al. 2019

ANZ Journal of Surgery

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Background: Splenectomy is a surgical procedure indicated in a variety of medical conditions including trauma. Postoperatively, there is a lifelong risk of developing overwhelming sepsis from encapsulated bacteria, most commonly due to Streptococcus pneumoniae. Splenic autotransplantation has been proposed as a method to recover splenic function in patients requiring splenectomy with otherwise normal spleens. This paper aims to systematically review the literature to determine the efficacy of spleen autotransplantation.Methods: MEDLINE, PubMed and the Cochrane Library were searched for all studies assessing splenic autotransplantation (January 1947 to July 2018). Data was extracted on study characteristics, outcomes assessed, including spleen scintigraphy results, blood film counts and serum immunoglobulin levels.Results: Data was obtained from 18 primary studies. All papers demonstrated return of regenerated spleen tissue in the majority of their patients (95.3%) on spleen scintigraphy. 90.2% of patients in 12 studies had blood films return to normal following transplantation. Immunoglobulin levels were shown to return to normal in all 12 studies where it was assessed. 3.7% of patients in 11 studies had postoperative complications.1.3% of patients in five studies had postoperative infections in the follow-up period.

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“…Desde el siglo pasado, el tratamiento del trauma del bazo ha ido cambiando, de ser quirúrgico en todos los casos 8,15,16 , a lo que se está haciendo en la actualidad, que es el manejo expectante y de observación 3,13,17,18 . Anteriormente, el tratamiento estándar para las lesiones esplénicas me-nores era la esplenectomía temprana, con el fin de evitar la hemorragia fatal.…”

Section: Discussionunclassified

“…Por esta razón, el trauma abdominal se convierte en la segunda causa de muerte por trauma cerrado, en la mayoría de los casos por hemorragia abdominal con posterior falla multiorgánica o sepsis 1,2 . El bazo es el órgano más frecuentemente lesionado, hasta en el 46 % de los casos de trauma cerrado 3,4 ; es un órgano que, por su abundante irrigación sanguínea y su localización, es el origen de hemorragias intraabdominales mayores 3,4 . Se registran mortalidades hasta del 38 % en los accidentes de tránsito, seguido de las caídas de diferentes alturas.…”

Section: Introductionunclassified

Caracterización de pacientes con trauma esplénico atendidos en un hospital de tercer nivel entre enero de 2000 y diciembre de 2017

et al. 2020

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Introducción. Es frecuente (46 %) que la lesión esplénica se acompañe de otra lesión visceral concomitante, con una alta tasa de morbimortalidad. La evolución de las técnicas para el abordaje de estas lesiones incluye procedimientos quirúrgicos, intervencionistas y de manejo expectante. Métodos. Se trata de un estudio con cohorte única retrospectiva y observacional. Se incluyeron pacientes mayores de 13 años de edad con trauma esplénico, atendidos entre enero de 2000 y diciembre de 2017. Se describieron las características relacionadas con el proceso de atención. Resultados. Se identificaron 116 pacientes con trauma esplénico, el 85,2 % de ellos hombres, con una edad promedio de 26 años. El 75,9 % de los pacientes presentaba lesiones concomitantes; las más frecuentes fueron de diafragma (31,0 %), de hígado (17,2 %) y de riñón (11,2 %). Los mecanismos de lesión más frecuentes fueron por arma corto-punzante (29,3 %), por arma de fuego (22,4 %) y por accidentes de tránsito (22,4 %). La gravedad fue clasificada como de grado V en el 24,1 % de los pacientes y de grado I en el 23,3 %. Se practicó esplenectomía total en el 39,7 % de los pacientes y el 15,2 % fue manejado de forma conservadora. La mortalidad fue del 4,3 %, tres casos en el posoperatorio inmediato (menos de 24 horas) y dos en la primera semana posoperatoria. Discusión. El manejo conservador de las lesiones esplénicas de poca gravedad es una estrategia segura y efectiva, con una tasa de fracaso de menos del 5. El abordaje quirúrgico se reserva para lesiones de mayor gravedad y su relación con otros órganos lesionados, con una mayor morbimortalidad (63 %)

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Primary Care of the Blunt Splenic Injured Adult

Cited by 10 publications

References 24 publications

Non-operative management of blunt splenic injury: is it really so extensively feasible? a critical appraisal of a single-center experience

Non-operative management of blunt splenic injury: is it really so extensively feasible? a critical appraisal of a single-center experience

Splenic autotransplantation: a systematic review

Caracterización de pacientes con trauma esplénico atendidos en un hospital de tercer nivel entre enero de 2000 y diciembre de 2017

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