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Management of Spleen Trauma in Polytrauma Patients

Works Count: 50163

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This cluster of papers focuses on the management of spleen trauma in polytrauma patients, including the use of CT imaging for diagnosis, nonoperative management strategies, risk of infection post-splenectomy, angiography for splenic injuries, and the interaction between spleen trauma and hepatic or renal injuries. It also discusses evidence-based guidelines and long-term outcomes after splenectomy.

Keywords

Spleen; Trauma; CT Imaging; Nonoperative Management; Splenectomy; Infection Risk; Angiography; Hepatic Trauma; Renal Injury; Guidelines

Systematic review of atraumatic splenic rupture

2009-09-28

Pietro Renzulli , Alexandre Hostettler , Alain Schoepfer +2 more

Atraumatic splenic rupture (ASR) is an ill defined clinicopathological entity.The aim was to characterize aetiological and risk factors for ASR-related mortality in order to aid disease classification and treatment. A … Atraumatic splenic rupture (ASR) is an ill defined clinicopathological entity.The aim was to characterize aetiological and risk factors for ASR-related mortality in order to aid disease classification and treatment. A systematic literature review (1980-2008) was undertaken and logistic regression analysis employed.Some 632 publications reporting 845 patients were identified. The spleen was normal in 7.0 per cent (atraumatic-idiopathic rupture). One, two or three aetiological factors were found in 84.1, 8.2 and 0.7 per cent respectively (atraumatic-pathological rupture). Six major aetiological groups were defined: neoplastic (30.3 per cent), infectious (27.3 per cent), inflammatory, non-infectious (20.0 per cent), drug- and treatment-related (9.2 per cent) and mechanical (6.8 per cent) disorders, and normal spleen (6.4 per cent). Treatment comprised total splenectomy (84.1 per cent), organ-preserving surgery (1.2 per cent) or conservative measures (14.7 per cent). The ASR-related mortality rate was 12.2 per cent. Splenomegaly (P = 0.040), age above 40 years (P = 0.007) and neoplastic disorders (P = 0.008) were associated with increased ASR-related mortality on multivariable analysis.The condition can be classified simply into atraumatic-idiopathic (7.0 per cent) and atraumatic-pathological (93.0 per cent) splenic rupture. Splenomegaly, advanced age and neoplastic disorders are associated with increased ASR-related mortality.

Blunt Hepatic Injury: A Paradigm Shift From Operative to Nonoperative Management in the 1990s

2000-06-01

Ajai K. Malhotra , Timothy C. Fabian , Martin A. Croce +4 more

To analyze the outcome of hemodynamically stable patients with blunt hepatic injury managed nonoperatively, and to examine the impact of this approach on the outcome of all patients with blunt … To analyze the outcome of hemodynamically stable patients with blunt hepatic injury managed nonoperatively, and to examine the impact of this approach on the outcome of all patients with blunt hepatic injury.Until recently, operative management has been the standard for liver injury. A prospective trial from the authors' institution had shown that nonoperative management could safely be applied to hemodynamically stable patients with blunt hepatic injury. The present study reviewed the authors' institutional experience with blunt hepatic trauma since that trial and compared the results with prior institutional experience.Six hundred sixty-one patients with blunt hepatic trauma during the 5-year period ending December 1998 were reviewed (NONOP2). The outcomes were compared with two previous studies from this institution: operative 1985 to 1990 (OP) and nonoperative 1993 to 1994 (NONOP1).All 168 OP patients were managed operatively. Twenty-four (18%) of 136 NONOP1 patients and 101 (15%) of the 661 NONOP2 patients required immediate exploration for hemodynamic instability. Forty-two (7%) patients failed nonoperative management; 20 were liver-related. Liver-related failures of nonoperative management were associated with higher-grade injuries and with larger amounts of hemoperitoneum on computed tomography scanning. Twenty-four-hour transfusions, abdominal infections, and hospital length of stay were all significantly lower in the NONOP1 and NONOP2 groups versus the OP cohort. The liver-related death rate was constant at 4% in the three cohorts over the three time periods.Although urgent surgery continues to be the standard for hemodynamically compromised patients with blunt hepatic trauma, there has been a paradigm shift in the management of hemodynamically stable patients. Approximately 85% of all patients with blunt hepatic trauma are stable. In this group, nonoperative management significantly improves outcomes over operative management in terms of decreased abdominal infections, decreased transfusions, and decreased lengths of hospital stay.

Enteral Versus Parenteral Feeding Effects on Septic Morbidity After Blunt and Penetrating Abdominal Trauma

1992-05-01

Kenneth A. Kudsk , Martin A. Croce , Timothy C. Fabian +5 more

To investigate the importance of route of nutrient administration on septic complications after blunt and penetrating trauma, 98 patients with an abdominal trauma index of at least 15 were randomized … To investigate the importance of route of nutrient administration on septic complications after blunt and penetrating trauma, 98 patients with an abdominal trauma index of at least 15 were randomized to either enteral or parenteral feeding within 24 hours of injury. Septic morbidity was defined as pneumonia, intra-abdominal abscess, empyema, line sepsis, or fasciitis with wound dehiscence. Patients were fed formulas with almost identical amounts of fat, carbohydrate, and protein. Two patients died early in the study. The enteral group sustained significantly fewer pneumonias (11.8% versus total parenteral nutrition 31.%, p < 0.02), intra-abdominal abscess (1.9% versus total parenteral nutrition 13.3%, p < 0.04), and line sepsis (1.9% versus total parenteral nutrition 13.3%, p < 0.04), and sustained significantly fewer infections per patient (p < 0.03), as well as significantly fewer infections per infected patient (p < 0.05). Although there were no differences in infection rates in patients with injury severity score < 20 or abdominal trauma index < 24, there were significantly fewer infections in patients with an injury severity score > 20 (p < 0.002) and abdominal trauma index > 24 (p < 0.005). Enteral feeding produced significantly fewer infections in the penetrating group (p < 0.05) and barely missed the statistical significance in the blunt-injured patients (p = 0.08). In the subpopulation of patients requiring more than 20 units of blood, sustaining an abdominal trauma index > 40 or requiring reoperation within 72 hours, there were significantly fewer infections per patient (p = 0.03) and significantly fewer infections per infected patient (p < 0.01). There is a significantly lower incidence of septic morbidity in patients fed enterally after blunt and penetrating trauma, with most of the significant changes occurring in the more severely injured patients. The authors recommend that the surgeon obtain enteral access at the time of initial celiotomy to assure an opportunity for enteral delivery of nutrients, particularly in the most severely injured patients.

Volume determinations using computed tomography

1982-02-01

RS Breiman , JOHN W. BECK , Melvyn Korobkin +5 more

Computed tomography potentially offers the most accurate noninvasive means of estimating in vivo volumes. Contiguous 1-cm-thick CT scans were obtained through phantoms, dog kidneys in vivo, and human spleens before … Computed tomography potentially offers the most accurate noninvasive means of estimating in vivo volumes. Contiguous 1-cm-thick CT scans were obtained through phantoms, dog kidneys in vivo, and human spleens before splenectomy. Cross-sectional areas were calculated for each individual scan and volumes then determined with each of four mathematical integration techniques. Volume estimations were compared to volumes determined by water displacement. The simplest, most practical means of calculating volumes, using the summation-of-areas technique with scans obtained at 2 cm intervals, was similar in accuracy to more complex methods. The mean percentage error of volume calculations using the sum-of-areas technique was 4.95% for five immobile phantoms, 3.86% for eight dog kidneys, 3.59% for eight human spleens in vivo at 1 cm scan spacing, and 3.65% for the same human spleens at 2 cm scan spacings. Difficulties in visual recognition and manual tracking of object boundaries seem to be more significant sources of error than patient-related factors.

Post-splenectomy and hyposplenic states

2011-04-07

Antonio Di Sabatino , Rita Carsetti , Gino Roberto Corazza

Nonoperative management of blunt hepatic injury

2012-10-31

Nicole A. Stassen , Indermeet S. Bhullar , Julius D. Cheng +7 more

During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative … During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline.The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed (http://www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma.One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury.Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Repeated imaging should be guided by a patient's clinical status. Adjunctive therapies like angiography, percutaneous drainage, endoscopy/endoscopic retrograde cholangiopancreatography and laparoscopy remain important adjuncts to nonoperative management of hepatic injuries. Despite the explosion of literature on this topic, many questions regarding nonoperative management of blunt hepatic injuries remain without conclusive answers in the literature.

Perioperative outcomes of laparoscopic versus open splenectomy: A meta-analysis with an emphasis on complications

2003-10-01

Emily R. Winslow , L. Michael Brunt

Incidence of Hollow Viscus Injury in Blunt Trauma: An Analysis from 275,557 Trauma Admissions from the EAST Multi-Institutional Trial

2003-02-01

Dorraine D. Watts , Samir M. Fakhry

Blunt hollow viscus injury (HVI) is uncommon. No sufficiently large series has studied the prevalence of these injuries in blunt trauma patients. This study defines the prevalence of blunt HVI, … Blunt hollow viscus injury (HVI) is uncommon. No sufficiently large series has studied the prevalence of these injuries in blunt trauma patients. This study defines the prevalence of blunt HVI, in addition to the associated morbidity and mortality rates for this diagnosis on the basis of a series of over 275,000 trauma admissions.Patients with blunt small bowel injury (SBI) were identified from the registries of 95 trauma centers for a 2-year period (1998-1999). Each HVI patient (case) was matched by age and Injury Severity Score with a blunt trauma patient receiving an abdominal workup who did not have HVI (control). Patient level data were abstracted by individual chart review. Institution level data were collected on total numbers for trauma admission demographics and on total diagnostic examinations performed.From 275,557 trauma admissions, 227,972 blunt injury patients were identified. HVI was rare, with 2,632 patients identified from this group. Perforating small bowel injury accounted for less than 0.3% of blunt admissions. Mortality and morbidity were high for HVI. Controlling for injury severity, patients with HVI were usually at higher risk of death than non-HVI patients.HVI is a rare but deadly phenomenon. The high mortality rates reflect the severity of the HVI and associated injuries. HVI patients should be carefully monitored for related injuries and complications.

A Prospective Study of Surgeon-Performed Ultrasound as the Primary Adjuvant Modality for Injured Patient Assessment

1995-09-01

Grace S. Rozycki , M. Gage Ochsner , Judy A. Schmidt +4 more

Ultrasound diagnostic imaging, having been used in Germany in the trauma setting for more than 15 years, has unique qualities that give it distinct advantages over other tests (DPL, CT), … Ultrasound diagnostic imaging, having been used in Germany in the trauma setting for more than 15 years, has unique qualities that give it distinct advantages over other tests (DPL, CT), and is gradually gaining acceptance by surgeons in the United States. In this prospective study, experienced surgeon sonographers successfully used ultrasound as the primary adjuvant modality to detect hemoperitoneum and pericardial effusion in injured patients. The ultrasound evaluations of 371 patients demonstrated that in 65 patients with significant injuries, ultrasound detected 53, that is, had an 81.5% sensitivity and 99.7% specificity. They conclude that ultrasound should be the primary adjuvant instrument for the evaluation of injured patients because it is rapid, accurate, and is potentially cost-effective.

Organ Injury Scaling

1995-03-01

Ernest E. Moore , Thomas H. Cogbill , Gregory J. Jurkovich +3 more

The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of Trauma (AAST) was organized formally in 1987; the fundamental purpose was to devise injury severity scores … The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of Trauma (AAST) was organized formally in 1987; the fundamental purpose was to devise injury severity scores for individual organs to facilitate clinical investigation and outcomes research. The OIS Committee members were selected on the basis of recognized clinical expertise as well as experience with injury scoring. The Committee was charged to develop a comprehensive set of OISs, monitor their application in the current literature, and recommend modifications when deemed appropriate. The following OISs for spleen and liver represent the first revisions in this long term project. Conceptually, the OIS is a classification scheme based on the anatomic disruption of an individual organ scaled 1 to 6, representing the least to most severe injury. Grades 1 to 5 represent increasingly complex injuries encountered in salvageable patients, while grade 6 is a destructive lesion incompatible with survival. Severity is based on potential threat to the patient's life, and the progressive scale derived from a comprehensive review of the current literature with consensus of the OIS Committee. Finally, the AAST Board of Managers approves all OISs prior to submission for publication. Despite this extensive preparation process, OISs are inherently limited by design as ordinal rather than interval scales. For example, the difference between a grade I versus II injury is generally less significant clinically than a grade IV versus V. The fundamental objective of the OIS, however, is not to assign prognostic value to a specific injury, but rather to provide a clearer description to facilitate comparison of an equivalent injury managed in one fashion versus another. To date, OISs have been developed and published in the Journal of Trauma for spleen, liver, kidney, [1] pancreas, duodenum, small bowel, colon, rectum, [2] chest wall, abdominal vascular, ureter, bladder, urethra, [3] and thoracic vascular, lung, cardiac, diaphragm. [4] While many of these OISs have been employed in clinical research, the individual scaling grades have not been studied independently for scientific accuracy. Nonetheless, with increased clinical testing and constructive review by other investigators, the need for revisions has become apparent. Spleen and liver OISs, first published in 1989, [1] have been applied frequently in the literature over the past five years, and describe two ongoing controversial areas in trauma care. Consequently, it is not surprising that revisions for these two OISs have become necessary. Some of these modifications were straightforward, while others required considerable deliberation of the OIS committee before a consensus could be reached. The significant revisions in the spleen and liver OIS include: 1) global downgrading of hematomas for both spleen and liver, acknowledging their relatively benign course with the advent of widespread CT scanning for blunt abdominal trauma, 2) addition of Couinard's segmental liver anatomy to facilitate quantification of lobar parenchymal disruption, employing internationally familiar terminology, 3) more rigorous criteria for grade IV and V hepatic injuries, recognizing the need to further delineate the operative challenges of these advanced lesions, and 4) restricting the advancement of one grade for multiple injuries within an OIS to grade III. The revised scale for spleen OIS is depicted in Table 1. The specific changes are increased threshold hematoma size to > 5cm for grade III, and elimination of ruptured intraparenchymal hematoma as a grade IV injury. The changes for the revised liver OIS (Table 2) are increased threshold hematoma size to > 10cm for grade III, increased amount of parenchyma involved to > 75% for grade V, and the addition of equivalent Counard segments for grade IV and grade V.Table 1: Spleen injury scale (1994 revision).Table 2: Liver injury scale (1994 revision).We hope these modifications will be helpful to those who employ OISs to improve care of the injured, and look forward to the evaluation of their scientific validity by experienced trauma surgeons.

American Association for the Surgery of Trauma Organ Injury Scale I: Spleen, Liver, and Kidney, Validation Based on the National Trauma Data Bank

2008-08-31

Glen Tinkoff , Thomas J. Esposito , James Reed +4 more

Normal liver, spleen, and kidney dimensions in neonates, infants, and children: evaluation with sonography.

1998-12-01

Öznur Leman Konuş , Alemiddin Özdemir , Ayça Esra Akkaya +3 more

The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy neonates, infants, and children.This prospective study involved 307 pediatric … The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy neonates, infants, and children.This prospective study involved 307 pediatric subjects (169 girls and 138 boys) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The subjects were 5 days to 16 years old. All measured organs were sonographically normal. At least two dimensions were obtained for each liver, spleen, and kidney. Relationships of the dimensions of these organs with sex, age, body weight, height, and body surface area were investigated. Suggested limits of normal dimensions were defined.Dimensions of the measured organs were not statistically different in boys and girls. Longitudinal dimensions of all three organs showed the best correlation with age, body weight, height, and body surface area. Height showed the strongest correlation of all. This correlation was a polynomial correlation.Determination of pathologic changes in size of the liver, spleen, and kidney necessitates knowing the normal range of dimensions for these organs in healthy neonates, infants, and children. Presented data are applicable in daily routine sonography. Body height should be considered the best criteria to correlate with longitudinal dimensions of these organs.

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NOTES ON THE ARREST OF HEPATIC HEMORRHAGE DUE TO TRAUMA

1908-10-01

J. HOGARTH PRINGLE

Lecturer on Surgery in Queen'xfififirlnggl'tegc.Surgeon to the Glasgow RUPTURE of the liver is fortunately an accident not often met with, but one which, when it is seen, may be associated … Lecturer on Surgery in Queen'xfififirlnggl'tegc.Surgeon to the Glasgow RUPTURE of the liver is fortunately an accident not often met with, but one which, when it is seen, may be associated with a condition of the patient as serious as any one can meet with in surgical practice.\Vhile small lacerations of the liver substance may be, and, no doubt are, recovered

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Not So Fast

2003-01-01

M. Todd Miller , Michael D. Pasquale , William Bromberg +2 more

Focused assessment with sonography for trauma (FAST) as a screening tool in the evaluation of blunt abdominal trauma will lead to underdiagnosis of abdominal injuries and may have an impact … Focused assessment with sonography for trauma (FAST) as a screening tool in the evaluation of blunt abdominal trauma will lead to underdiagnosis of abdominal injuries and may have an impact on treatment and outcome in trauma patients.From October 2001 to June 2002, a protocol for evaluating hemodynamically stable trauma patients with suspected blunt abdominal injury (BAI) admitted to our institution was implemented using FAST examination as a screening tool for BAI and computed tomographic (CT) scanning of the abdomen and pelvis as a confirmatory test. At the completion of the secondary survey, patients underwent a four-view FAST examination (Sonosite, Bothell, WA) followed within 1 hour by an abdominal/pelvic CT scan. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid. Clinical, laboratory, and imaging results were recorded at admission, and FAST examination results were compared with CT scan findings, noting the discordance.Patients with suspicion for BAI were evaluated according to protocol (n = 372). Thirteen cases were excluded for inadequate FAST examinations, leaving 359 patients for analysis. There were 313 true-negative FAST examinations, 16 true-positives, 22 false-negatives, and 8 false-positives. Using CT scanning as the confirmatory test for hemoperitoneum, FAST examination had a sensitivity of 42%, a specificity of 98%, a positive predictive value of 67%, a negative predictive value of 93%, and an accuracy of 92%; chi analysis showed significant discordance between FAST examination and CT scan (5.85%, < 0.001). Six patients with false-negative FAST examinations required laparotomy for intra-abdominal injuries; 16 patients required admission for nonoperative management of injury. Of the 313 true-negative FAST examinations, 19 patients were noted to have intra-abdominal injuries without hemoperitoneum and 11 patients were noted to have retroperitoneal injuries.Use of FAST examination as a screening tool for BAI in the hemodynamically stable trauma patient results in underdiagnosis of intra-abdominal injury. This may have an impact on treatment and outcome in trauma patients. Hemodynamically stable patients with suspected BAI should undergo routine CT scanning.

The Born-Again Spleen

1978-06-22

Howard A. Pearson , Dorothy Johnston , Karen Smith +1 more

We assessed splenic activity after splenectomy by interference phase microscopical examination of circulating red cells. Normal eusplenic children had a low number (<1 per cent) of red cells with surface … We assessed splenic activity after splenectomy by interference phase microscopical examination of circulating red cells. Normal eusplenic children had a low number (<1 per cent) of red cells with surface indentations or "pits." About 20 per cent of red cells of children who had electively been subjected to splenectomy for hematologic indications were "pitted." Thirteen of 22 children who had had emergency splenectomy because of traumatic injury had a low percentage of "pitted" red cells, suggesting a return of splenic function. In five of these children a 99mTc sulfur colloid scan demonstrated multiple nodules of recurrent splenic tissue. In contrast to the prevailing opinion that splenosis is rare, we have found it to be a frequent occurrence. Return of splenic function may, in part, account for the low frequency with which overwhelming bacterial sepsis and meningitis have been documented after splenectomy for traumatic indications. (N Engl J Med 298:1389–1392, 1978)

Polyvalent Pneumococcal-Polysaccharide Immunization of Patients with Sickle-Cell Anemia and Patients with Splenectomy

1977-10-27

Arthur J. Ammann , Joseph E. Addiego , Diane W. Wara +3 more

To reduce the risk of infection from Streptococcus pneumoniae in hyposplenic patients we administered octavalent pneumococcal vaccine to 77 patients with sickle-cell disease and 19 asplenic persons and compared their … To reduce the risk of infection from Streptococcus pneumoniae in hyposplenic patients we administered octavalent pneumococcal vaccine to 77 patients with sickle-cell disease and 19 asplenic persons and compared their response with 82 controls (38 age-matched normal persons and 44 normal black African children). Fifty micrograms each of pneumococcal-polysaccharide Types 1, 3, 6, 7, 14, 18, 19 and 23 were administered subcutaneously. Post-immunization serums (three to four weeks) were available from 52 of 77 patients with sickle-cell disease; the per cent responding and the magnitude of the indirect hemagglutination response were comparable to those of the controls. Within two years after immunization we observed eight Str. pneumoniae infections in 106 age-matched unimmunized patients with sickle-cell disease, but none in the 77 immunized (P<0.025). We conclude that pneumococcal polysaccharides are immunogenic in hyposplenic patients and may protect against systemic Str. pneumoniae infection. (N Engl J Med 297:897–900, 1977)

Blunt Splenic Injury in Adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma

2000-08-01

Andrew B. Peitzman , Brian Heil , Louis Rivera +7 more

Background 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 purpose of this multi-institutional … Background 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 purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. Methods A total of 1,488 adults (>15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended χ2 test. Data are expressed as mean ± SD; a value of p < 0.05 was considered significant. Results A total of 38.5% of patients went directly to the operating room (group I); 61.5% of patients were admitted with planned nonoperative management. Of the patients admitted with planned observation, 10.8% failed and required laparotomy; 82.1% of patients with an Injury Severity Score (ISS) < 15 and 46.6% of patients with ISS > 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9%), II (22.4%), III (38.1%), IV (73.7%), and V (94.9%) (p < 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8%), II (9.5%), III (19.6%), IV (33.3%), and V (75.0%) (p < 0.05). A total of 60.9% of the patients failed nonoperative management within 24 hours of admission; 8% failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9% of patients with small hemoperitoneum, 49.4% of patients with moderate hemoperitoneum, and 72.6% of patients with large hemoperitoneum. Conclusion In this multicenter study, 38.5% of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8% of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8%, with 60.9% of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.

Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries

1998-10-01

Grace S. Rozycki , Robert B. Ballard , David V. Feliciano +2 more

To determine the accuracy of the Focused Assessment for the Sonographic examination of the Trauma patient (FAST) when performed by trauma team members during a 3-year period, and to determine … To determine the accuracy of the Focused Assessment for the Sonographic examination of the Trauma patient (FAST) when performed by trauma team members during a 3-year period, and to determine the clinical conditions in which the FAST is most accurate in the assessment of injured patients.The FAST is a rapid test that sequentially surveys the pericardial region for hemopericardium and then the right and left upper quadrants and pelvis for hemoperitoneum in patients with potential truncal injuries. The clinical conditions in which the FAST is most accurate in the assessment of injured patients have yet to be determined.FAST examinations were performed on patients with precordial or transthoracic wounds or blunt abdominal trauma. Patients with a positive ultrasound (US) examination for hemopericardium underwent immediate surgery, whereas those with a positive US for hemoperitoneum underwent a computed tomography scan (if they were hemodynamically stable) or immediate celiotomy (if they were hemodynamically unstable- blood pressure < or = 90 mmHg).FAST examinations were performed in 1540 patients (1227 with blunt injuries, 313 with penetrating injuries). There were 1440 true-negative results, 80 true-positive results, 16 false-negative results, and 4 false-positive results; the sensitivity was 83.3%, the specificity 99.7%. US was most sensitive and specific for the evaluation of patients with precordial or transthoracic wounds (sensitivity 100%, specificity 99.3%) and hypotensive patients with blunt abdominal trauma (sensitivity 100%, specificity 100%).US should be the initial diagnostic modality for the evaluation of patients with precordial wounds and blunt truncal injuries because it is rapid and accurate. Because of the high sensitivity and specificity of US in the evaluation of patients with precordial wounds and hypotensive patients with blunt torso trauma, immediate surgical intervention is justified when those patients have a positive US examination.

PROSPECTIVE EVALUATION OF SURGEONS' USE OF ULTRASOUND IN THE EVALUATION OF TRAUMA PATIENTS

1993-04-01

Grace S. Rozycki , M. Gage Ochsner , Jonathan H. Jaffin +1 more

Ultrasound diagnostic imaging has been demonstrated to be a valuable investigative tool in the evaluation of trauma patients in Europe and Japan. In the United States, however, ultrasound has not … Ultrasound diagnostic imaging has been demonstrated to be a valuable investigative tool in the evaluation of trauma patients in Europe and Japan. In the United States, however, ultrasound has not been widely used by trauma surgeons because of its lack of availability in the trauma resuscitation area and the associated cost and lack of full-time availability of a technician. In this prospective study, four attending trauma surgeons, four trauma fellows (PGY 6 and 7), and 25 surgical residents (PGY 4) at a level I trauma center were trained in specific ultrasound techniques to identify fluid in trauma patients with thoracoabdominal injuries. Their ultrasound evaluations of 476 patients demonstrated that in 90 patients with clinically significant injuries, ultrasound imaging successfully detected injury in 71, for a 79% sensitivity. Specificity was 95.6%. We conclude that (1) surgeons can rapidly and accurately perform and interpret ultrasound examinations; and (2) ultrasound is a rapid, sensitive, specific diagnostic modality for detecting intraabdominal fluid and pericardial effusion.

Pooling of platelets in the spleen: role in the pathogenesis of "hypersplenic" thrombocytopenia.

1966-05-01

Richard H. Aster

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Status of Nonoperative Management of Blunt Hepatic Injuries in 1995

1996-01-01

H. Leon Pachter , M. Margaret Knudson , Barry C. Esrig +7 more

Introduction Nonoperative management is presently considered the treatment modality of choice in over 50% of adult patients sustaining blunt hepatic trauma who meet inclusion criteria. A multicenter study was retrospectively … Introduction Nonoperative management is presently considered the treatment modality of choice in over 50% of adult patients sustaining blunt hepatic trauma who meet inclusion criteria. A multicenter study was retrospectively undertaken to assess whether the combined experiences at level I trauma centers could validate the currently reported high success rate, low morbidity, and virtually nonexistent mortality associated with this approach. Thirteen level I trauma centers accrued 404 adult patients sustaining blunt hepatic injuries managed nonoperatively over the last 5 years. Seventy-two percent of the injuries resulted from motor vehicle crashes. The mean injury severity score for the entire group was 20.2 (range, 4-75), and the American Association for the Surgery of Trauma-computerized axial tomography scan grading was as follows: grade I, 19% (n = 76); grade II, 31% (n = 124); grade III, 36% (n = 146); grade IV, 10% (n = 42); and grade V, 4% (n = 16). There were 27 deaths (7%) in the series, with 59% directly related to head trauma. Only two deaths (0.4%) could be attributed to hepatic injury. Twenty-one (5%) complications were documented, with the most common being hemorrhage, occurring in 14 (3.5%). Only 3 (0.7%) of these 14 patients required surgical intervention, 6 were treated by transfusions alone (0.5 to 5 U), 4 underwent angio-embolization, and 1 was further observed. Other complications included 2 bilomas and 3 perihepatic abscesses (all drained percutaneously). Two small bowel injuries were initially missed (0.5%), and diagnosed 2 and 3 days after admission. Overall, 6 patients required operative intervention: 3 for hemorrhage, 2 for missed enteric injuries, and 1 for persistent sepsis after unsuccessful percutaneous drainage. Average length of stay was 13 days. Nonoperative management of blunt hepatic injuries is clearly the treatment modality of choice in hemodynamically stable patients, irrespective of grade of injury or degree of hemoperitoneum. Current data would suggest that 50 to 80% (47% in this series) of all adult patients with blunt hepatic injuries are candidates for this form of therapy. Exactly 98.5% of patients analyzed in this study successfully avoided operative intervention. Bleeding complications are infrequently encountered (3.5%) and can often be managed nonoperatively. Although grades IV and V injuries composed 14% of the series, they represented 66.6% of the patients requiring operative intervention and thus merit constant re-evaluation and close observation in critical care units. The optimal time for follow-up computerized axial tomography scanning seems to be within 7 to 10 days after injury.

Nonoperative Management of Blunt Hepatic Trauma Is the Treatment of Choice for Hemodynamically Stable Patients Results of a Prospective Trial

1995-06-01

Martin A. Croce , Timothy C. Fabian , Paul G. Menke +6 more

Background A number of retrospective studies recently have been published concerning nonoperative management of minor liver injuries, with cumulative success rates greater than 95%. However, no prospective analysis that involves … Background A number of retrospective studies recently have been published concerning nonoperative management of minor liver injuries, with cumulative success rates greater than 95%. However, no prospective analysis that involves a large number of higher grade injuries has been reported. The current study was conducted to evaluate the safety of nonoperative management of blunt hepatic trauma in hemodynamically stable patients regardless of injury severity. Methods Over a 22-month period, patients with blunt hepatic injury were evaluated prospectively. Unstable patients underwent laparotomies, and stable patients had abdominal computed tomography (CT) scans. Those with nonhepatic operative indications underwent exploration, and the remainder were managed nonoperatively in the trauma intensive care unit. This group was compared with a hemodynamically matched operated cohort of blunt hepatic trauma patients (control subjects) who had been prospectively analyzed. Results One hundred thirty-six patients had blunt hepatic trauma. Twenty-four (18%) underwent emergent exploration. Of the remaining 112 patients, 12 (11%) failed observation and underwent celiotomy–5 were liver-related failures (5%) and 7 were nonliver related (6%). Liver related failure rates for CT grades I through V were 20%, 3%, 3%, 0%, and 12%, respectively, and rates according to hemoperitoneum were 2% for minimal, 6% for moderate, and 7% for large. The remaining 100 patients were successfully treated without operation–30% had minor injuries (grades I–II) and 70% had major (grades III–V) injuries. There were no differences in admission characteristics between nonoperative success or failures, except admission systolic blood pressure (127 vs. 104; p < 0.04). Comparing the nonoperative group to the control group, there were no differences in admission hemodynamics or hospital length of stay, but nonoperative patients had significantly fewer blood transfusions (1.9 vs. 4.0 units; p < 0.02) and fewer abdominal complications (3% vs. 11%; p < 0.04).

Selective nonoperative management of blunt splenic injury

2012-10-31

Nicole A. Stassen , Indermeet S. Bhullar , Julius D. Cheng +7 more

During the last century, the management of blunt force trauma to the spleen has changed from observation and expectant management in the early part of the 1900s to mainly operative … During the last century, the management of blunt force trauma to the spleen has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the Practice Management Guidelines for Non-operative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the current EAST guideline.The National Library of Medicine and the National Institute of Health MEDLINE database was searched using Pub Med (www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords splenic injury and blunt abdominal trauma.One hundred seventy-six articles were reviewed, of which 125 were used to create the current practice management guideline for the selective nonoperative management of blunt splenic injury.There has been a plethora of literature regarding nonoperative management of blunt splenic injuries published since the original EAST practice management guideline was written. Nonoperative management of blunt splenic injuries is now the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury, patient age, or the presence of associated injuries. Its use is associated with a low overall morbidity and mortality when applied to an appropriate patient population. Nonoperative management of blunt splenic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and has an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt splenic injuries. Repeat imaging should be guided by a patient's clinical status. Adjunctive therapies like angiography with embolization are increasingly important adjuncts to nonoperative management of splenic injuries. Despite the explosion of literature on this topic, many questions regarding nonoperative management of blunt splenic injuries remain without conclusive answers in the literature.

Relatively Short Diagnostic Delays (<8 Hours) Produce Morbidity and Mortality in Blunt Small Bowel Injury: An Analysis of Time to Operative Intervention in 198 Patients from a Multicenter Experience

2000-03-01

Samir M. Fakhry , Michelle R. Brownstein , Dorraine D. Watts +2 more

Objective: Blunt small bowel injury (SBI) is uncommon, and its timely diagnosis may be difficult. The impact of operative delays on morbidity and mortality has been unclear. The purpose of … Objective: Blunt small bowel injury (SBI) is uncommon, and its timely diagnosis may be difficult. The impact of operative delays on morbidity and mortality has been unclear. The purpose of this study was to determine the relationship of diagnostic delays to morbidity and mortality in blunt SBI. Methods: Patients with blunt SBI with perforation were identified from the registries of eight trauma centers (1989–1997). Patients with duodenal injuries were excluded. Data were extracted by individual chart review. Patients were classified as multi-trauma (group 1) or near-isolated SBI (group 2 with Abbreviated Injury Scale score < 2 for other body areas). Time to operation and its impact on mortality and morbidity was determined for each patient. Results: A total of 198 patients met inclusion criteria: 66.2% were male, mean age was 35.2 years (range, 1–90 years) and mean Injury Severity Score was 16.7 (range, 9–47). 100 patients had multiple injuries (group 1). There were 21 deaths (10.6%) with 9 (4.5%) attributable to delay in operation for SBI. In patients with near-isolated SBI, the incidence of mortality increased with time to operative intervention (within 8 hours: 2%; 8–16 hours: 9.1%; 16–24 hours: 16.7%; greater than 24 hours: 30.8%, p = 0.009) as did the incidence of complications. Delays as short as 8 hours 5 minutes and 11 hours 15 minutes were associated with mortality attributable to SBI. The rates of delay in diagnosis were not significantly associated with age, gender, intoxication, transfer status, or presence of associated injuries. Conclusion: Delays in the diagnosis of SBI are directly responsible for almost half the deaths in this series. Even relatively brief delays (as little as 8 hours) result in morbidity and mortality directly attributable to "missed" SBI. Further investigation into the prompt diagnosis of this injury is needed.

Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum.

1990-11-01

Emma Moore , Thomas H. Cogbill , Mark A. Malangoni +7 more

The Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) has been charged to devise injury severity scores for individual organs to facilitate clinical … The Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) has been charged to devise injury severity scores for individual organs to facilitate clinical research. Our first report (1) addressed O.I.S.'s for the Spleen, Liver, and Kidney; the following are proposed O.I.S.'s for Pancreas (Table I), Duodenum (Table II), Small Bowel (Table III), Colon (Table IV), and Rectum (Table V). The grading scheme is fundamentally an anatomic description, scaled from 1 to 5, representing the least to the most severe injury. We emphasize that these O.I.S.'s represent an initial classification system which must undergo continued refinement as clinical experience dictates.

Practice Management Guidelines for Selective Nonoperative Management of Penetrating Abdominal Trauma

2010-03-01

John J. Como , Faran Bokhari , William C. Chiu +5 more

Background: Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating injury to the abdomen, it is also clear that certain stable … Background: Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating injury to the abdomen, it is also clear that certain stable patients without peritonitis may be managed without operation. The practice of deciding which patients may not need surgery after penetrating abdominal wounds has been termed selective management. This practice has been readily accepted during the past few decades with regard to abdominal stab wounds; however, controversy persists regarding gunshot wounds. Because of this, the Eastern Association for the Surgery of Trauma Practice Management Guidelines Committee set out to develop guidelines to analyze which patients may be managed safely without laparotomy after penetrating abdominal trauma. A secondary goal of this committee was to find which diagnostic adjuncts are useful in the determination of the need for surgical exploration. Methods: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed (www.pubmed.gov). Results: The search retrieved English language articles concerning selective management of penetrating abdominal trauma and related topics from the years 1960 to 2007. These articles were then used to construct this set of practice management guidelines. Conclusions: Although the rate of nontherapeutic laparotomies after penetrating wounds to the abdomen should be minimized, this should never be at the expense of a delay in the diagnosis and treatment of injury. With this in mind, a routine laparotomy is not indicated in hemodynamically stable patients with abdominal stab wounds without signs of peritonitis or diffuse abdominal tenderness. Likewise, it is also not routinely indicated in stable patients with abdominal gunshot wounds if the wounds are tangential and there are no peritoneal signs. Abdominopelvic computed tomography should be considered in patients selected for initial nonoperative management to facilitate initial management decisions. The majority of patients with penetrating abdominal trauma managed nonoperatively may be discharged after 24 hours of observation in the presence of a reliable abdominal examination and minimal to no abdominal tenderness. Diagnostic laparoscopy may be considered as a tool to evaluate diaphragmatic lacerations and peritoneal penetration in an effort to avoid unnecessary laparotomy.

Organ Injury Scaling

1989-12-01

Ernest E. Moore , Steven R. Shackford , H. Leon Pachter +7 more

The Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) was appointed by President Trunkey at the 1987 Annual Meeting. The principal charge was … The Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) was appointed by President Trunkey at the 1987 Annual Meeting. The principal charge was to devise injury severity scores for individual organs to facilitate clinical research. The resultant classification scheme is fundamentally an anatomic description, scaled from 1 to 5, representing the least to the most severe injury. A number of similar scales have been developed in the past, but none has been uniformly adopted. In fact, this concept was introduced at the A.A.S.T. in 1979 as the Abdominal Trauma Index (A.T.I.) and has proved useful in several areas of clinical research. The enclosed O.I.S.'s for spleen, liver, and kidney represent an amalgamation of previous scales applied for these organs, and a consensus of the O.I.S. Committee as well as the A.A.S.T. Board of Managers. The O.I.S. differs from the Abbreviated Injury Score (A.I.S.), which is also based on an anatomic scale but designed to reflect the impact of a specific organ injury on ultimate patient outcome. The individual A.I.S.'s are, of course, the basic elements used to calculate the Injury Severity Score (I.S.S.) as well as T.R.I.S.S. methodology. To ensure that the O.I.S. interdiffuses with the A.I.S. and I.C.D.-9 codes, these are listed alongside the respective O.I.S. Both the currently used A.I.S. 85 and proposed A.I.S. 90 are provided because of the obligatory transition period. Indeed, A.I.S. 90 contains the identical descriptive text as the current O.I.S.'s. The Abdominal Trauma Index and other similar indices using organ injury scoring can be easily modified by replacing older scores with the O.I.S.'s.(ABSTRACT TRUNCATED AT 250 WORDS)

Splenic Embolization Revisited: A Multicenter Review

2004-03-01

James M. Haan , Walter L. Biffl , M. Margaret Knudson +6 more

Background Splenic embolization can increase nonoperative salvage. However, complications are not clearly defined. A retrospective multicenter review was performed to delineate the risks and benefits of splenic embolization. Methods A … Background Splenic embolization can increase nonoperative salvage. However, complications are not clearly defined. A retrospective multicenter review was performed to delineate the risks and benefits of splenic embolization. Methods A retrospective chart review of all patients undergoing splenic embolization from 1997 to 2002 at four separate Level I trauma centers was performed. Reviewed results included patient demographics, admission and follow-up computed tomographic scan results, angiographic technique, and patient outcomes including splenic salvage rate and procedural complications. Results A total of 140 patients were reviewed. The majority were young male patients involved in motor vehicle crashes. These patients had high abdominal computed tomographic grades of splenic injury and moderate Injury Severity Scores. The splenic salvage rate was 87%, which decreased with increasing injury grade. However, over 80% of splenic injury grades 4 and 5 were successfully managed nonoperatively. Significant hemoperitoneum did not affect success, but the presence of arteriovenous fistula was associated with a high failure rate, even with embolization. Salvage rates were similar between main coil and subselective embolization groups. Patients over 55 years of age did no worse than younger patients. Major complications included bleeding in 16 patients; 6 splenic abscesses, with 5 patients requiring splenectomy; and 1 episode of arterial injury requiring operative repair. Conclusion Splenic embolization remains a valuable technique in splenic salvage, especially in higher grade injuries. Complications are common but do not seem to affect outcome.

Indications for operation in abdominal trauma

1960-05-01

Gerald W. Shaftan

Evolution in the Management of Hepatic Trauma: A 25-Year Perspective

2000-09-01

J. David Richardson , Glen A. Franklin , James Lukan +6 more

To define the changes in demographics of liver injury during the past 25 years and to document the impact of treatment changes on death rates.No study has presented a long-term … To define the changes in demographics of liver injury during the past 25 years and to document the impact of treatment changes on death rates.No study has presented a long-term review of a large series of hepatic injuries, documenting the effect of treatment changes on outcome. A 25-year review from a concurrently collected database of liver injuries documented changes in treatment and outcome.A database of hepatic injuries from 1975 to 1999 was studied for changes in demographics, treatment patterns, and outcome. Factors potentially responsible for outcome differences were examined.A total of 1,842 liver injuries were treated. Blunt injuries have dramatically increased; the proportion of major injuries is approximately 16% annually. Nonsurgical therapy is now used in more than 80% of blunt injuries. The death rates from both blunt and penetrating trauma have improved significantly through each successive decade of the study. The improved death rates are due to decreased death from hemorrhage. Factors responsible include fewer major venous injuries requiring surgery, improved outcome with vein injuries, better results with packing, and effective arterial hemorrhage control with arteriographic embolization.The treatment and outcome of liver injuries have changed dramatically in 25 years. Multiple modes of therapy are available for hemorrhage control, which has improved outcome.

Iron and Susceptibility to Infectious Disease

1974-05-31

Eugene D. Weinberg

Risk of Infection and Death Among Post-splenectomy Patients

2001-10-01

Naiel Bisharat , Hussam Omari , I. Lavi +1 more

Vascular complications after splenectomy for hematologic disorders

2009-07-28

Shelley E. Crary , George R. Buchanan

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SPLENIC STUDIES

1952-08-01

Harold King , Harris B. Shumacker

Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee

2004-05-01

Richard A. Santucci , Hunter Wessells , Georg Bartsch +5 more

To determine the optimal evaluation and management of renal injuries by review of the world's English-language literature on the subject.A consensus conference convened by the World Health Organization and the … To determine the optimal evaluation and management of renal injuries by review of the world's English-language literature on the subject.A consensus conference convened by the World Health Organization and the Societé Internationale d'Urologie met to critically review reports of the diagnosis and treatment of renal trauma. The English-language literature about renal trauma was identified using Medline, and additional cited works not detected in the initial search obtained. Evidence-based recommendations for the diagnosis and management of renal trauma were made with reference to a five-point scale.There were many Level 3 and 4 citations, few Level 2, and one Level 1 which supported clinical practice patterns. Findings of nearly 200 reviewed citations are summarized.Published reports on renal trauma still rely heavily on expert opinion and single-institution retrospective case series. Prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates the behaviour of practitioners.

Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury

2000-02-01

Steven Stylianos

Patient Survival after Human Albumin Administration

2001-08-07

Mahlon M. Wilkes , Roberta J. Navickis

To test the hypothesis that albumin administration is not associated with excess mortality.Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical … To test the hypothesis that albumin administration is not associated with excess mortality.Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of reference lists.Randomized, controlled trials comparing albumin therapy with crystalloid therapy, no albumin, or lower doses of albumin.Two investigators independently extracted data. The primary end point was relative risk for death. Criteria used to assess methodologic quality were blinding, method of allocation concealment, presence of mortality as a study end point, and crossover. Small-trial bias was also investigated.Fifty-five trials involving surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications were included. Albumin administration did not significantly affect mortality in any category of indications. For all trials, the relative risk for death was 1.11 (95% CI, 0.95 to 1.28). Relative risk was lower among trials with blinding (0.73 [CI, 0.48 to 1.12]; n = 7), mortality as an end point (1.00 [CI, 0.84 to 1.18]; n = 17), no crossover (1.04 [CI, 0.89 to 1.22]; n = 35), and 100 or more patients (0.94 [CI, 0.77 to 1.14]; n = 10). In trials with two or more such attributes, relative risk was further reduced.Overall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.

Nonoperative Management of Blunt Splenic Injury: A 5-Year Experience

2005-03-01

James M. Haan , Grant V. Bochicchio , Nils Krämer +1 more

Objectives: The purpose of this study was to examine the success rate of nonoperative management of blunt splenic injury in an institution using splenic embolization. Methods: We conducted a retrospective … Objectives: The purpose of this study was to examine the success rate of nonoperative management of blunt splenic injury in an institution using splenic embolization. Methods: We conducted a retrospective review of all patients admitted to a Level I trauma center with blunt splenic injury. Data review included patient demographics, computed tomographic (CT) scan results, management technique, and patient outcomes. Results: A total of 648 patients with blunt splenic injury were admitted, 280 of whom underwent immediate surgical management. Three hundred sixty-eight underwent planned nonoperative management, and 70 patients were treated with observation, serial abdominal examination, and follow-up abdominal CT scanning. All were hemodynamically stable, with a 100% salvage rate. One hundred sixty-six patients had a negative angiogram, with a nonoperative salvage rate of 94%, and 132 patients underwent embolization, with a nonoperative salvage rate of 90%. Overall salvage rates decreased with increasing injury grade; however, over 80% of grade 4 and 5 injuries were successfully managed nonoperatively. The salvage rate was similar for main coil embolization versus selective or combined embolization techniques. Admission abdominal CT scan correlated with splenic salvage rates. Significant hemoperitoneum, extravasation, and pseudoaneurysm had acceptable salvage rates, whereas arteriovenous fistula had a high failure rate, even after embolization. Conclusion: Splenic embolization is a valuable adjunct to splenic salvage in our experience, allowing for the increased use of nonoperative management and higher salvage rates for American Association for the Surgery of Trauma splenic injury grades when compared with prior studies. Main coil embolization has a similar salvage rate when compared with other angiographic techniques. An arteriovenous fistula as a CT finding was predictive of a 40% nonoperative failure rate.

Postsplenectomy sepsis and its mortality rate: Actual<i>versus</i>perceived risks

1991-09-01

R J Holdsworth , Andy Irving , A. Cuschieri

Abstract A collective critical review of the literature on postsplenectomy sepsis from 1952 to 1987 has been undertaken. The reports cover a cohort of 12 514 patients undergoing splenectomy but … Abstract A collective critical review of the literature on postsplenectomy sepsis from 1952 to 1987 has been undertaken. The reports cover a cohort of 12 514 patients undergoing splenectomy but of these only 5902 reports were sufficiently detailed to allow a useful analysis. The incidence of infection after splenectomy in children under 16 years old was 4.4 per cent with a mortality rate of 2.2 per cent. The corresponding figures for adults were 0.9 per cent and 0.8 per cent respectively. The present analysis of well documented patients has shown that severe infection after splenectomy for benign disease is very uncommon except in infants (infection rate 15.7 per cent) and children below the age of 5 years (infection rate 10.4 per cent). Many of these reported postsplenectomy infections may have been coincidental. It is also apparent that children contract a different type of infection after splenectomy than adults, predominantly a meningitis which is less frequently fatal. Adults, in contrast, appear to develop a septicaemic type of illness associated with a higher mortality rate. This survey has also shown that children are reported to be no more susceptible to pneumococcal sepsis than to infection caused by any other organism. Although the removal of the spleen in otherwise normal people does not appear to be associated with an increased frequency of infection, the presence of a coexistent disorder, notably hepatic disease, can increase the risk substantially.

Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: Prepared on behalf of the British Committee for Standards in Haematology by a Working Party of the Haemato‐Oncology Task Force

2011-10-12

John Davies , Michael Lewis , Jennie Wimperis +3 more

Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were first published by the British Committee for Standards in Haematology (BCSH) in 1996 … Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were first published by the British Committee for Standards in Haematology (BCSH) in 1996 and formally reviewed in 2002. Although the guidelines originated from discussion within the BCSH, the intended readership is wide given the multidisciplinary nature of the management of hyposplenism.

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Whole Body Imaging in Blunt Multisystem Trauma Patients Without Obvious Signs of Injury

2006-05-01

Alí Salim , Burapat Sangthong , Matthew J. Martin +3 more

The use of liberal whole body imaging (pan scan) in patients based on mechanism is warranted, even in evaluable patients with no obvious signs of chest or abdominal injury.Prospective observational … The use of liberal whole body imaging (pan scan) in patients based on mechanism is warranted, even in evaluable patients with no obvious signs of chest or abdominal injury.Prospective observational study.Academic level I trauma center.All patients admitted following blunt multisystem trauma.Pan scan, including computed tomography (CT) of the head, cervical spine, chest, abdomen, and pelvis, with the following inclusion criteria: (1) no visible evidence of chest or abdominal injury, (2) hemodynamically stable, (3) normal abdominal examination results in a neurologically intact patient or unevaluable abdominal examination results secondary to a depressed level of consciousness, and (4) significant mechanisms of injury. Radiological findings and changes in treatment based on these findings were recorded.Any alteration in the normal treatment plan as a direct result of CT scan findings. These alterations include early hospital discharge, admission for observation, operative intervention, and additional diagnostic studies or interventions.One thousand patients underwent pan scan during the 18-month observation period, of which 592 were evaluable patients with no obvious signs of abdominal injury. Clinically significant abnormalities were found in 3.5% of head CT scans, 5.1% of cervical spine CT scans, 19.6% of chest CT scans, and 7.1% of abdominal CT scans. Overall treatment was changed in 18.9% of patients based on abnormal CT scan findings.The use of pan scan based on mechanism in awake, evaluable patients is warranted. Clinically significant abnormalities are not uncommon, resulting in a change in treatment in nearly 19% of patients.

Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed

2001-03-01

D J Waghorn

Patients without spleens are at increased risk of overwhelming infection. Recently, greater efforts, including the publication of national guidelines, have been made to improve the management of asplenic individuals. In … Patients without spleens are at increased risk of overwhelming infection. Recently, greater efforts, including the publication of national guidelines, have been made to improve the management of asplenic individuals. In theory, risks of serious sepsis can be reduced by good advice, immunisation, and antibiotic prophylaxis. In practice, such preventive measures might not be followed or may fail. A study of recent cases of overwhelming postsplenectomy infection (OPSI) was undertaken to examine specific associated factors and to determine whether currently recommended preventive measures are being followed.Cases of OPSI were identified and reported mainly by microbiologists across the country using a specifically designed proforma. Data including the nature of the infection and vaccination/ antibiotic prophylaxis history since splenectomy were obtained.Seventy seven cases were reported. The age range varied from 3 months (congenital asplenia) to 87 years. In those who had undergone surgical splenectomy, the time interval between surgery and OPSI varied from 24 days to 65 years. Overall mortality reached 50%, with underlying haematological malignancy associated with the highest death rate. Streptococcus pneumoniae caused approximately 90% episodes. Only 31% individuals had received pneumococcal vaccination before OPSI. Seven of 17 pneumococcal infections in immunised cases could be considered vaccine failures. Few patients had been adequately advised on antibiotic prophylaxis or other measures.Currently accepted best practice for managing asplenic patients is not being followed. Some OPSI cases may still be preventable but many asplenic individuals remain unrecognised. The compilation of asplenic patient registers might help to implement agreed policies with audit necessary to evaluate compliance. More is needed to ensure optimal management for this cohort of the population.

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Organ Injury Scaling

1995-04-01

Ernest E. Moore , Thomas H. Cogbill , Mark A. Malangoni +4 more

Risk of Infection after Penetrating Abdominal Trauma

1984-10-25

Ronald Lee Nichols , Jeffrey W. Smith , Daniel B. Klein +4 more

To identify the risk factors for the development of postoperative septic complications in patients with intestinal perforation after abdominal trauma, and to compare the efficacies of single-drug and dual-drug prophylactic … To identify the risk factors for the development of postoperative septic complications in patients with intestinal perforation after abdominal trauma, and to compare the efficacies of single-drug and dual-drug prophylactic antibiotic therapy, we studied 145 patients who presented with abdominal trauma and intestinal perforation at two hospitals between July 1979 and June 1982. Logistic-regression analysis showed that a higher risk of infection (P<0.05) was associated with increased age, injury to the left colon necessitating colostomy, a larger number of units of blood or blood products administered at surgery, and a larger number of injured organs. The presence of shock on arrival, which was found to increase the risk of infection when this factor was analyzed individually, did not add predictive power. Patients with postoperative sepsis were hospitalized significantly longer than were patients without infection (13.8 vs. 7.7 days, P<0.0001). Both treatment regimens — cefoxitin given alone and clindamycin and gentamicin given together—resulted in similar infection rates, drug toxicity, duration of hospitalization, and costs. (N Engl J Med 1984; 311: 1065–70.)

Hazard of Overwhelming Infection after Splenectomy in Childhood

1967-06-01

Angelo J. Eraklis , Sherwin V. Kevy , L. Diamond +1 more

THE exact role of the spleen in preventing or suppressing bacterial infections in human beings is unknown. The spleen, an important part of the reticuloendothelial system, acts as a filter … THE exact role of the spleen in preventing or suppressing bacterial infections in human beings is unknown. The spleen, an important part of the reticuloendothelial system, acts as a filter for circulating debris including bacteria and as an important source of lymphoid cells and antibody production. There should therefore be little doubt that splenectomy may alter the ability to prevent or to suppress some infections. However, in a child, the extent to which this change is clinically significant has been a source of continuing controversy.Since the initial report by King and Shumacker in 19521 a number of articles have . . .

CONGENITAL HEMOLYTIC JAUNDICE CORRECTED BY SPLENECTOMY FOLLOWED TWENTY-SIX YEARS LATER BY BLEEDING TENDENCY, HEPATOMEGALY AND SUDDEN DEATH.

1965-02-01

Gerald Klatskin

Post splenectomy sepsis

1973-01-01

Db. Singer

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

2017-08-18

Federico Coccolini , Giulia Montori , Fausto Catena +7 more

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration … Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

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Organ injury scaling 2018 update: Spleen, liver, and kidney

2018-09-05

Rosemary A. Kozar , Marie Crandall , K. Shanmuganathan +6 more

Kozar, Rosemary A. MD, PhD; Crandall, Marie MD; Shanmuganathan, Kathirkamanthan MD; Zarzaur, Ben L. MD; Coburn, Mike MD; Cribari, Chris MD; Kaups, Krista MD; Schuster, Kevin MD; Tominaga, Gail T. … Kozar, Rosemary A. MD, PhD; Crandall, Marie MD; Shanmuganathan, Kathirkamanthan MD; Zarzaur, Ben L. MD; Coburn, Mike MD; Cribari, Chris MD; Kaups, Krista MD; Schuster, Kevin MD; Tominaga, Gail T. MD; the AAST Patient Assessment Committee Author Information

CAR Recommendations for the Management of Incidental Findings of the Spleen and Nodes in Adults

2025-06-25

Jeffery R. Bird , Gary Brahm , Christopher Fung +3 more | Canadian Association of Radiologists Journal

The Canadian Association of Radiologists Incidental Findings Working Group (CAR IFWG) has developed new recommendations for the management of incidental findings of the spleen, lymph nodes, peritoneum, and mesentery, tailored … The Canadian Association of Radiologists Incidental Findings Working Group (CAR IFWG) has developed new recommendations for the management of incidental findings of the spleen, lymph nodes, peritoneum, and mesentery, tailored to the Canadian healthcare context. This guidance addresses splenomegaly, focal splenic lesions, splenic artery aneurysms, lymphadenopathy, mesenteric panniculitis, and peritoneal nodules. Building on prior American College of Radiology (ACR) guidance and integrating recent evidence, the CAR IFWG offers a pragmatic approach emphasizing radiologic features, clinical context, and patient risk factors to minimize unnecessary follow-up. The recommendations aim to streamline care, reduce patient anxiety, and support radiologists in distinguishing benign from potentially malignant findings in asymptomatic individuals.

The role of kidney-preserving surgery in renal trauma: A nationwide analysis

2025-06-24

Masaki Ito , Kyosuke Takahashi , Madeleine Burg +5 more | Surgery

About the management of patients with wandering spleen in pregnancy and postpartum

2025-06-24

Brunialti Daniela , Sonia Prader | Archives of Gynecology and Obstetrics

This study aimed to review the literature with regard to the management and outcome in pregnant and postpartum females with wandering spleen. The literature was reviewed for articles regarding the … This study aimed to review the literature with regard to the management and outcome in pregnant and postpartum females with wandering spleen. The literature was reviewed for articles regarding the following search terms: 'pregnancy', 'postpartum', 'torsion' and 'wandering spleen'. 17 articles were found in medical literature from 1907 to 2022. Case reports were divided up into 2 groups: antepartum group that counts 12 articles and the postpartum group with 5 articles. The median age of these females was 28 years. All patients had symptoms across both groups: abdominal pain (n=13), vomiting (n=5), thrombocytopenia (n=4), nausea (n=3) and thrombocytosis (n=2). 16 patients underwent splenectomy and 1 pregnant woman received conservative management during pregnancy. 15 patients had no post-operative complications. 1 woman had an incomplete abortion in the 1 st trimester and 1 female a stillbirth in the 3 rd trimester. Wandering spleen in pregnancy and in puerperium is a rare condition with many different possible manifestations. Up to now literature has favored laparoscopic or open splenectomy as treatment for it. From asymptomatic patients to urgent and emergent cases, the diagnosis of a wandering spleen must be included when a pregnant or postpartum woman complains about an abdominal palpable mass and recurrent abdominal pain.

Mesenteric Shearing in a Pediatric Patient, Successfully Managed Conservatively: A Case Report

2025-06-24

Karim Sabeh-Ayoun , Nour Bakhos , Mustafa Natout +1 more | European Journal of Pediatric Surgery Reports

Introduction Mesenteric shear, injury due to sudden stretch of the mesentery, is a rare condition that remains poorly studied, especially in the pediatric population. Often resulting from trauma, its presentation … Introduction Mesenteric shear, injury due to sudden stretch of the mesentery, is a rare condition that remains poorly studied, especially in the pediatric population. Often resulting from trauma, its presentation can vary from nonspecific and vague abdominal symptoms to an acute abdomen and peritonitis requiring urgent surgical intervention. Unified management strategies are not yet in place. Case presentation We describe the case of a ten-year-old boy who presented to the emergency department with diffuse abdominal pain of one day duration, two days after he sustained blunt abdominal trauma with an elbow during a soccer match. He was hemodynamically and clinically stable. Computed Tomography (CT) scan revealed soft tissue thickening in the left upper quadrant at the root of the mesentery with mild surrounding inflammatory mesenteric fat stranding, suggesting mesenteric shearing. With stable vitals, a soft abdomen on physical exam and no drop in hemoglobin, decision was made to treat the patient conservatively. The patient was admitted for observation, and after frequent abdominal exams, stable lab results and abdominal imaging, he was discharged home without any surgical intervention. Conclusion Conservative management can be successful in case of a stable patient without alarming physical, lab, or imaging findings. Observation and close monitoring remain essential to detect complicated cases that require surgical intervention.

Isolated Synchronous Splenic Metastasis from Endometrial Carcinoma: Case Report

2025-06-23

Nagihan Kolkıran , Mehmet Gürdal Savsar , Gonca Akdere ATEŞ +3 more | Düzce Tıp Fakültesi Dergisi

Endometrial carcinoma is the most prevalent malignancy of the female reproductive system. However, splenic metastasis remains an infrequent occurrence due to the spleen's distinct anatomical and microenvironmental characteristics. This case … Endometrial carcinoma is the most prevalent malignancy of the female reproductive system. However, splenic metastasis remains an infrequent occurrence due to the spleen's distinct anatomical and microenvironmental characteristics. This case report described a 66-year-old female patient diagnosed with endometrial carcinoma, who underwent total hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, omentectomy, and splenectomy following the intraoperative detection of splenic metastasis. The histopathological evaluation confirmed high-grade serous carcinoma with a Ki-67 proliferation index of 90%, as well as metastatic involvement of the ovaries, peritoneum, and spleen. The patient subsequently received adjuvant carboplatin-paclitaxel chemotherapy, radiotherapy, and multiple-step systemic therapy due to disease progression. No significant adverse effects were observed in multi-step chemotherapy. The present case demonstrates the diagnostic challenges and treatment strategies encountered in a rare occurrence of endometrial carcinoma with splenic metastasis.

Might less be more: Management of blunt liver and spleen injuries in pediatric patients

2025-06-23

Michael L Nance , David M. Notrica , Christian J. Streck | Journal of Trauma and Acute Care Surgery

Diagnostic Accuracy of Computed Tomography Abdomen with Surgical Findings for Blunt Abdominal Injury Cases

2025-06-23

Mohamad Asmawi Mohamad Ariffin , Muhammad Khalis Abdul Karim , Mohd Azizi Abdul Rahman +5 more | Asian Journal of Medicine and Health

Aims: Computed tomography (CT) has become a widely used imaging modality for evaluating blunt abdominal injury (BAI) due to its ability to provide detailed anatomical information. This study aims to … Aims: Computed tomography (CT) has become a widely used imaging modality for evaluating blunt abdominal injury (BAI) due to its ability to provide detailed anatomical information. This study aims to investigate the correlation between CT abdomen findings with surgical findings in cases of BAI, to assess the accuracy and reliability of CT in diagnosing and guiding surgical intervention. Study Design and Methodology: A retrospective study was conducted on a cohort of patients (n=100), clinically suspected of BAI who underwent CT abdomen and surgical procedure. The sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of each solid organ were calculated. Results: Most of the organs involves are liver (37%) followed by kidney (29%) and spleen (19%). Patient with pancreas and adrenal injuries were low, 8% and 7% each other. CT revealed great sensitivity for the liver (98%), kidneys (98%) and adrenal (89%), and moderate sensitivity for the spleen (85%) and pancreas (80%). All the solid organs have high positive predictive value (PPV) and negative predictive value (NPV), with kidneys having the largest range (PPV: 100% and NPV: 98%). The overall validity of CT was excellent in evaluating BAI cases. The results of this study indicate a strong correlation between CT abdomen findings and surgical findings in BAI cases. CT also showed abnormal findings like contusion, hematoma, laceration and vascular injury in most BAI cases. Conclusion: The accuracy and reliability of CT highlight its significance, guiding appropriate surgical intervention and optimizing patient outcomes.

Analysis of factors associated with length of stay in renal trauma patients: a single-centre retrospective study

2025-06-23

Paksi Satyagraha , Besut Daryanto , Bagas Wilianto +1 more | Archivio Italiano di Urologia e Andrologia

Renal trauma represents a critical injury requiring precise management with the length of hospital stay (LOS) serving as a key metric for trauma care. Recognizing the factors contributing to extended … Renal trauma represents a critical injury requiring precise management with the length of hospital stay (LOS) serving as a key metric for trauma care. Recognizing the factors contributing to extended LOS is essential for optimizing treatment strategies and enhancing patient outcomes. This study aims to analyse the risk factors influencing LOS in patients with renal trauma. This retrospective cohort study was conducted at Dr. Saiful Anwar General Hospital, Malang, analysing medical record data of renal trauma patients from 2013 to 2023. Collected variables included demographics, mechanism of injury, associated injuries, hemodynamic status upon admission, injury severity, haemoglobin levels, LOS, management approach, and mortality outcomes. Univariate and multivariate analyses were performed to assess the impact of each variable on LOS. 119 renal trauma patients were included. The average age was 40.1 ± 16.86 years, and 77.3% of the participants were male. The average LOS was 6.85 ± 3.85 days. Blunt renal trauma was the predominant mechanism, accounting for 95.8% of cases, while associated injuries were observed in 53.1% of patients. Upon hospital admission, 66.4% of cases presented with stable hemodynamic status, and non-operative management was employed in 92.4% of cases. Prolonged LOS was significantly associated with age, blunt trauma, associated injuries, hemodynamic instability, and low haemoglobin levels in both univariate and multivariate analyses. Age, mechanism of injury, associated injuries, hemodynamic status at admission, and haemoglobin levels significantly impact LOS in renal trauma patients. Identifying these factors may aid in improving patient management and reducing hospitalization duration.

Prise en charge d’une plaie pénétrante du rein

2025-06-23

Thibaut Long Depaquit , Y. Vincent , C. Aguéro +3 more | Annales d Urologie

Bile leak - liver traumatic laceration

2025-06-21

Bruno Di Muzio | Radiopaedia.org

Thromboembolic Events Are Increased After Splenectomy in Postmenopausal Women

2025-06-20

Qi Feng , Yi Mu , Christopher Kabrhel +3 more | American Journal of Hematology

Wandering spleen presenting as a pelvic mass: A rare case report and literature review

2025-06-20

Hajar Siouri , Hajar Betari , Amal Mojahid +5 more | Radiology Case Reports

Case Study: Abdominal Contusion with Intestinal Perforation Secondary to Rifle Recoil Trauma (Tbourida)

2025-06-20

M. Benzakour , Erragh Anas , Safia Chaabi +3 more | INTERNATIONAL JOURNAL OF HEALTH & MEDICAL RESEARCH

We report the case of a 45-year-old man with no medical history who was admitted to the emergency department 18 hours after abdominal trauma caused by rifle recoil during a … We report the case of a 45-year-old man with no medical history who was admitted to the emergency department 18 hours after abdominal trauma caused by rifle recoil during a fantasia (tbourida) demonstration. The patient presented with vomiting, hypogastric abdominal pain, and signs of generalized abdominal guarding. Surgical exploration revealed a small bowel perforation, confirmed by the operative image. This case highlights the potential severity of blunt abdominal trauma in a non-military or classic accidental setting, emphasizing the need for rapid management.

Spontaneous Rupture of Hepatocellular Adenoma During Pregnancy Complicated by Intrauterine Fetal Death

2025-06-19

Ariana Bárbara , Cassandra Lemper , Marcos D'Ippolito +1 more | Cureus

What’s your diagnosis? Pneumonia, splenic and subcutaneous abscesses

2025-06-18

Hailong Li , Li Zhao , Ying Wang +1 more | Intensive Care Medicine

The clinical efficacy and safety of ERCP in traumatic pancreatic injuries: a systematic review and meta-analysis

2025-06-18

Hulusi Can Karpuzcu , Çağdaş Erdoǧan | World Journal of Emergency Surgery

MRI timing and clinical outcomes in blunt moderate-severe pancreatic trauma: Implications for practice management and care optimization

2025-06-17

Andrew Ford , Nikita Nunes Espat , Philip Lee +5 more | The American Journal of Emergency Medicine

Revisiting surgical decisions: The choice between laparotomy and laparoscopy for traumatic small bowel injuries

2025-06-17

Hui‐Fen Chiu , Shih‐Ching Kang , Chih‐Yuan Fu | Surgery

INTESTINAL TRAUMA

2025-06-16

Carlos Á. Iglesias , Richard Fabián Espinoza Durán , Bryam Esteban Coello García | EPRA International Journal of Multidisciplinary Research (IJMR)

Introduction: intestinal injuries, mainly in the small bowel, occur due to blunt or penetrating trauma, with greater severity in the latter. Rapid assessment is crucial to improve prognosis due to … Introduction: intestinal injuries, mainly in the small bowel, occur due to blunt or penetrating trauma, with greater severity in the latter. Rapid assessment is crucial to improve prognosis due to the physical and ischemic damage that compromises intestinal viability. Objective: to detail current information related to intestinal trauma, etiology, pathophysiology, epidemiology, evaluation, treatment, complications and care. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 21 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: intestinal trauma, abdominal trauma, penetrating abdominal trauma, abdominal contusion, surgical emergencies. Results: the diagnosis of intestinal injuries follows a protocol that includes anamnesis, physical examination and studies such as radiography, FAST ultrasound, tomography and laparoscopy, the latter useful to avoid unnecessary laparotomies. Management depends on hemodynamic stability: stable patients with closed trauma are observed, while unstable patients require laparotomy; in penetrating injuries, surgery is urgent in unstable patients and conservative management is an option in stable patients. Primary repair is used in minor injuries, and early postoperative enteral nutrition improves recovery and reduces complications. Conclusions: Traumatic bowel injuries present a diagnostic and therapeutic challenge because of their clinical variety and complications. Rapid assessment with studies and protocols guide management, where surgery is key in unstable patients, and early enteral nutrition improves postoperative outcomes, with hemodynamic stability and timely diagnosis being fundamental for prognosis. Keywords: trauma, bowel, evaluation, surgery, nutrition.

Wenn die Erkrankung im Gepäck mitreist

2025-06-16

Jonathan Remppis , Mirjam Freudenhammer , Johanna Weekes +7 more | Monatsschrift Kinderheilkunde

The Enigmatic Wandering Spleen: Managing Three Cases in a Tertiary Setting

2025-06-16

Mohammed Al Blooshi , Abdalla Aboelkheir , Avinash Hiremath +2 more | Research Square (Research Square)

<title>Abstract</title> Wandering spleen is a rare clinical entity characterized by abnormal mobility of the spleen due to laxity or absence of its supporting ligaments. In pediatric patients, this condition can … <title>Abstract</title> Wandering spleen is a rare clinical entity characterized by abnormal mobility of the spleen due to laxity or absence of its supporting ligaments. In pediatric patients, this condition can present with vague abdominal symptoms or acute torsion leading to infarction, posing a significant diagnostic challenge. Early identification through imaging and timely intervention are crucial to preserve splenic function. Conducted in a tertiary care setting, we report three pediatric cases of wandering spleen, each illustrating a different clinical course and surgical management strategy. The first case involved a 13-year-old girl with progressive abdominal pain and vomiting, ultimately requiring splenectomy after unsuccessful detorsion attempts. The second case featured a 10-year-old girl with a previously known pelvic spleen who underwent successful laparotomy and splenopexy upon finding a partially viable spleen. The third case involved a 3-year-old girl with fever, acute pain, and imaging evidence of an ectopic spleen; intraoperative detorsion and splenopexy preserved splenic tissue, underscoring the importance of salvage when possible. These cases highlight the variable presentation of wandering spleen, the pivotal role of imaging in diagnosis, and underscore that splenic salvage should be prioritized whenever feasible to maintain immunologic function. Splenopexy remains the preferred option for viable spleens, while splenectomy is reserved for nonviable organs, with adequate follow-up essential to monitor for potential postoperative complications.

Letter re: “The use and timing of angioembolization in pediatric blunt liver and spleen injury”

2025-06-13

Nikita Nunes Espat , Nickolas Hernandez , Adel Elkbuli | Journal of Trauma and Acute Care Surgery

Clinical Study on MDCT Values of Intestinal Wall in Traumatic Mesenteric Laceration withIntestinal Necrosis

2025-06-13

Shi-Gang Gao | Research Square (Research Square)

<title>Abstract</title> <bold>Purpose: </bold>To conduct a clinical study on the MDCT values of intestinal wall in traumaticmesenteric laceration with intestinal necrosis and provide guidance for clinical diagnosis andtreatment. <bold>Methods:</bold> A retrospective … <title>Abstract</title> <bold>Purpose: </bold>To conduct a clinical study on the MDCT values of intestinal wall in traumaticmesenteric laceration with intestinal necrosis and provide guidance for clinical diagnosis andtreatment. <bold>Methods:</bold> A retrospective collection was made of 76 cases of mesenteric lacerationconfirmed by surgery from September 2019 to February 2025. Among them, 10 cases underwentemergency abdominal enhanced CT examination and were confirmed by pathology and surgery tohave mesenteric laceration with intestinal necrosis. The CT values of normal and necroticintestinal walls in plain scan and venous phase were measured. Independent sample t-test, pairedt-test, binary logistic regression analysis and receiver operating characteristic (ROC) curveanalysis were performed for evaluation. <bold>Results:</bold> There was a statistically significant difference in CT values between necrotic and normalintestinal walls in the venous phase of abdominal enhanced CT (P < 0.05); there was a statisticallysignificant difference in CT values between normal intestinal walls in plain scan and venous phase(P < 0.05); there was no statistically significant difference in CT values between necrotic intestinalwalls in plain scan and venous phase (P > 0.05). The ROC curve analysis results showed 0.960,significance 0.001, sensitivity 90%, specificity 90%, and the optimal cut-off value was 78.75. <bold>Conclusion: </bold>Emergency abdominal enhanced CT has a high predictive value for intestinalnecrosis after blunt abdominal mesenteric laceration and is of great significance for theformulation of clinical treatment plans.

Spontaneous Splenic Rupture Revealed by Hemorrhagic Shock in the Peripartum Period: A Case Report

2025-06-13

K. Ouaaziz , S. Dehbi , PA M. Arfaoui +3 more | Scholars Journal of Medical Case Reports

Background: Spontaneous splenic rupture during pregnancy is an extremely rare and life-threatening condition, often diagnosed late due to nonspecific symptoms and absence of trauma. Case Presentation: We report the case … Background: Spontaneous splenic rupture during pregnancy is an extremely rare and life-threatening condition, often diagnosed late due to nonspecific symptoms and absence of trauma. Case Presentation: We report the case of a 36-year-old woman, gravida 5 para 4, admitted at 36 weeks of gestation for acute fetal distress. An emergency cesarean section revealed massive hemoperitoneum. Surgical exploration identified a spontaneous grade 4 splenic rupture. A hemostatic splenectomy was performed with favorable maternal and neonatal outcomes. Conclusion: Although rare, spontaneous splenic rupture should be considered in pregnant women presenting with unexplained hemorrhagic shock. Prompt diagnosis and surgical intervention are critical to improve prognosis.

Acute Torsion of the Wandering Spleen: A Case Report

2025-06-11

Ahchari Kaoutar , Tirizite Nabil , Haissoune Ahmed +5 more | Scholars Journal of Medical Case Reports

The wandering spleen is caused by congenital absence of suspensory ligaments or abnormally long ligaments [1]. It is an uncommon clinical condition. The clinical presentation of wandering spleen is variable, … The wandering spleen is caused by congenital absence of suspensory ligaments or abnormally long ligaments [1]. It is an uncommon clinical condition. The clinical presentation of wandering spleen is variable, but the most dangerous complication is splenic torsion [2], which can subsequently cause splenic infarction and rupture. We present a case of a 17-year-old girl who presented with acute abdominal pain and an abdominal contrast enhanced computed tomography revealed complete splenic infarction due to torsion of the splenic pedicle, consistent with a wandering spleen. The patient underwent an emergent laparotomy through a midline incision. A spleen was found, with its pedicle completely torsed. The spleen had no attachments to the abdominal wall or diaphragm and appeared non vital. as de-rotation did not revascularize the organ. A total splenectomy was performed without complications, and she was discharged in stable condition on the fifth postoperative day, with appropriate post-splenectomy antibiotic prophylaxis and immunizations. During the 3 month follow-up, the patient showed normal conditions with no recurrent episodes of abdominal pain.

Severe liver injuries in a contemporary national trauma registry: In-hospital mortality remains high regardless of therapeutic approach

2025-06-04

Terry R. Schaid , Ernest E. Moore , Renaldo Williams +4 more | Surgery

Evaluating the reproducibility of AAST-OIS CT scoring for splenic injuries: the need for standardization

2025-06-03

Skander Sammoud , Sophie Bastide , Julien Ghelfi +5 more | La radiologia medica

Letter to the Editor for “Prognostic Value of the Measurement at Admission of the Inferior Vena Cava in Acute Pancreatitis”

2025-06-02

Venkata Dileep Kumar Veldi , Rachana Mehta , Ranjana Sah | Journal of Hepato-Biliary-Pancreatic Sciences

POS1243 SERUM URATE LEVELS AND RECURRENT GOUT FLARE EVENTS AND GOUT-PRIMARY HOSPITALISATIONS: GENERAL POPULATION-BASED INCEPTION COHORT OF >62,000 NEWLY-DIAGNOSED GOUT PATIENTS

2025-06-01

Ran Abuhasira , Itay Hazan , C. Yokose +2 more | Annals of the Rheumatic Diseases

Atraumatic splenic rupture in a man in his 70s: unusual cause of acute abdomen and shock

2025-06-01

Shreya Sengupta , Violet Alavi , Wenlong Zhao | BMJ Case Reports

A man in his 70s presented to the emergency department with a 2 week history of abruptly worsening abdominal pain, with no history of trauma, culminating in transient loss of … A man in his 70s presented to the emergency department with a 2 week history of abruptly worsening abdominal pain, with no history of trauma, culminating in transient loss of consciousness. Although initially stable, he rapidly deteriorated despite aggressive fluid resuscitation, with systolic blood pressure and haemoglobin measuring at 66 mm Hg and 86 g/L at their lowest, respectively. This prompted the initiation of the massive transfusion protocol due to haemorrhagic shock. The patient was urgently transferred to theatres and on surgical exploration, active bleeding from the left upper quadrant necessitated splenectomy. He recovered well postoperatively and was discharged with the appropriate prophylaxis. This case demonstrates the importance of considering atraumatic splenic rupture (ASR) in acute abdominal pain, as its vague presentation often leads to failed diagnoses. Patients require prompt stabilisation and surgical intervention. Vaccinations and lifelong prophylactic antibiotics are recommended to prevent postsplenectomy infections.

Revisiting Isolated Blunt Pancreatic Trauma; Five-year Surgical Experience in a Tertiary Trauma Centre

2025-05-31

Prabhakar Mishra , Amit Singh , Ganpat Prasad | Indian Journal of Critical Care Medicine

Intramural Hematoma of the Duodenum in a Four-Year-Old Child Following a Blunt Bicycle Handlebar Injury: A Case Report

2025-05-30

Olga Gryszkiewicz , Marek Wolski | Cureus

Determinants for premature rupture of membranes: a prospective cohort study

2025-05-30

Yizhou Jiang , Yan Zhang , Yuyan Li +3 more | BMC Pregnancy and Childbirth

MODERN STRATEGIES AND TECHNOLOGIES IN SURGICAL TREATMENT OF SPLENIC CYST

2025-05-29

R.B. Lysenko , І.І. Nіemtchenko , V.V. Shtompel +1 more | Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії

Introduction. Splenic cysts are rare benign pathological formations of the spleen, which are often asymptomatic and can be accidentally detected during imaging studies. Objective. This is a poorly studied pathology … Introduction. Splenic cysts are rare benign pathological formations of the spleen, which are often asymptomatic and can be accidentally detected during imaging studies. Objective. This is a poorly studied pathology due to its rarity and, accordingly, requires coverage and more in-depth investigation. Materials and methods. A literature search was conducted using electronic databases to identify relevant studies. Analysis and synthesis of scientific information were performed based on available publications focused on the surgical treatment of splenic cysts. Results. Modern strategies and current possibilities for the surgical treatment of splenic cysts are presented. The advantages and limitations of various approaches are discussed, including minimally invasive techniques, laparoscopic procedures, and the emerging role of robotic surgery. Prospects for further research in this field are also outlined. A critical review of the available literature highlights the importance of surgeons being proficient in both open and laparoscopic methods, with particular emphasis on spleenpreserving techniques. Conclusions. An individual choice of the method of surgical treatment of splenic cysts depends on the localization, size, relationship to the architectonics of the vessels, and the variant of damage to the splenic parenchyma based on radiation diagnostic methods. Modern strategies demonstrate the need for a wide integration of minimally invasive treatment methods and organ-preserving operations. Modern surgical technologies allow to provide optimal results with minimal postoperative complications.