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Consideration on the nonoperative treatment of blunt splenic injury

Keywords: NONOPERATIVE MANAGEMENT , BLUNT SPLENIC INJURY , TOMOGRAPHY

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Abstract:

A prospective study (2008-2009) 30 patients with Blunt Splenic Injuries or NOM. The hemoperitoneum was established by USG (100%). The extent of parenchimatous organ injury was quantified at CT 27(90%) cases. Laparoscopy was performed in 6(20%) cases for assessing USG sensitivity. The following parameters were recorded: age, sex,trauma mechanism, Glasgow scale, trauma score (RTS), trauma severity score (ISS), diagnostic procedures, value of hemoperitoneum as a predictive factor, volume of blood transfusions,morbidity and mortality. The criteria for NOM selection included hemodinamyc stability,radiologic confirmation of splenic injury and absence of other abdominal trauma which would need surgical treatment. Based on our tomographic findings, we tried, according to different tomographic grading systems of blunt injuries of the spleen to predict the need for surgery. The Schweizer tomographic scale and the Resciniti score do not have predictive value neither in thereported nor in our results. The new MDTC system that incorporates LVL seems to have predictive value and the possibility to decrease the failure rates of NMO by embolization opportunities for grade 4a and 4b lesions. The decision to perform laparotomy should not bebased solely on the results of tomographic grading, surgical tactics being decided only in complex with clinical parameters.

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