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Criteria for nonoperative management of blunt splenic trauma
Sarmast Shoushtary MH,Askarpour Sh,Asgari M,Talaiezadeh A
Tehran University Medical Journal , 2009,
Abstract: "nBackground: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and diagnostic criteria for selection of patients for surgery. "nMethods: One hundred and one patients with blunt splenic injury entered in our prospective observational and cross sectional study. Patients with unstable hemodyna-mics and obvious abdominal symptoms underwent emergency splenectomy was performed. In stable patients, abdominal and pelvic CT scan with IV contrast was performed. Patients with stable hemodynamics who lack obvious abdominal symptoms, admitted in ICU ward. Patients' demographics, blood pressure changes, hemoglobin concertration, severity of trauma with injury severity score (ISS) scoring system, CT scan findings, amount of blood transfusion; Hospitalization time and mechanism of injury were recorded. "nResults: From 101 patients, 61(60.3%) underwent early laparotomy. 40 patients were planned for conservative management. In 30 patients (29.7%) nonoperative management was successful. In 10 patients (9.9%) This management failed and they underwent surgery. Hypotension, hemoglobin concentration dropping more than one episode and blood transfusion requirement more than one time, increased the risk of operation. Higher ISS number and ISS≥16 had a direct relation with operative management. In patients who underwent early laparotomy CT grade of injury was higher. CT findings correlated well with laparotomy findings. "nConclusion: Nonoperative management was successful in 75% of selected patients. With correct selection of patients and concerning to homodynamic status, hemoglobin concentration changes and injury severity score in conjunction with CT findings, we can use this management in greater number of patients.
Nonoperative management of blunt and penetrating splenic traumas  [PDF]
Selin Kapan,Ahmet Nuray Turhan,Halil Al??,Bar?? Demiriz
Medical Journal of Bakirk?y , 2005,
Abstract: Aim: Current management for splenic trauma had been shifted towards conservative approaches with nonoperative therapy. In this retrospective study, splenic trauma cases managed nonoperatively in our clinic for the last three years have been evaluated and the advantages of nonoperative approach have been discussed. Material and Methods: Twenty-one splenic trauma cases admitted to our Emergency Room between July 2003 and September 2005 were evaluated retrospectively. Results: Female to male ratio was 7/14 with a mean age of 27.57±2.34 (13-53). The etiologies of the trauma type were falls from a height in 7 cases, penetrating stab wound in 6 cases, pedestrians struck in 6 cases, motor vehicle collision in 1 case and assault in another. Abdominal ultrasonography and computerized tomography were performed to all cases before hospitalization. During the hospitalization period serial abdominal examinations and serial hemoglobin follow up were performed under strict bed rest. Grades of injuries according to the American Trauma Association Organ Injury score were Grade I in 8 cases, Grade II in 9 cases, Grade III in, 3 cases, and Grade IV in 4 cases. Nonoperative management was performed to 17 cases (81%) whereas 4 cases (19%) were operated for hemodynamic instability. Mean hospital stay was 6.52 ± 0.75 (2-15) days. The only mortality occured in a case with injury due to motor vehicle collision operated for multitrauma (4.76%). All of the remaining cases were discharged from the hospital without any problem. Conclusion: Hemodynamically stable splenic trauma cases especially with Grade I, II, III injuries can safely be managed by nonoperative approach and unnecessary splenectomies can be avoided.
NonOperative Management of Blunt Solid Abdominal Organ Injury in Calabar, Nigeria  [PDF]
Asuquo Maurice, Bassey Okon, Etiuma Anietimfon, Ngim Ogbu, Ugare Gabriel, Anthonia Ikpeme
International Journal of Clinical Medicine (IJCM) , 2010, DOI: 10.4236/ijcm.2010.11006
Abstract: Background: Over the past several years, nonoperative management has been increasingly recommended for the care of selected blunt abdominal trauma patients with solid organ injuries. Objective: To evaluate the pattern and outcome of blunt abdominal trauma using haemodynamic stability and ultrasonography in the selection of patients for nonoperative management in a facility without computed tomogram. Methods: Patients admitted with blunt abdominal trauma between February 2005 and January 2010 were prospectively studied. Haemodynamic stability and sonography formed the basis for selecting patients for nonoperative management. Results: In total, 58 patients suffered blunt abdominal trauma and 19(33%) patients were successfully managed nonoperatively suffered blunt solid abdominal organ injuries. Road traffic accidents inflicted 17(89%) patients while 2(11%) patients sustained sports injury (football). The spleen was the commonest solid organ injured 12(60%), while the liver and kidney were injured in 6(30%) and 2(10%) respectively. Associated injuries were fractured left femur recorded in 3(16%) patients and fractured rib in a patient (5%). Conclusion: Nonoperative treatment is a safe and effective method in the management of haemodynamically stable patient with blunt solid abdominal organ injury. This translated to a reduction in hospital stay, absence of the risk of blood transfusion as well as attendant morbidity and mortality associated with laparotomy. Establishment of trauma system, provision of diagnostic and monitoring facilities, good roads, and education on road safety is recommended for improved outcome.
Is Bowel Rest a Prerequisite for Successful Outcome in Nonoperative Management of Extrahepatic Bile Duct Blunt Injury in Children?
S Al Jadaan, O Oda, S Crankson, M Al Namshaan, M Zamakhshary
Annals of Pediatric Surgery , 2010,
Abstract: Extrahepatic bile duct injury resulting from blunt abdominal trauma in children is not common. Nonoperative management has become the standard of care. During a two-year period from January 2005 to December 2006, we treated 1015 pediatric traumas. Of those, 103 were blunt abdominal trauma. Only two patients had injury to the extrahepatic bile ducts. Both cases were managed nonoperatively; however, the clinical presentation required a different approach. Facilitation of bile flow by means of sphincterotomy, or putting a transampullary stent, had the most significant impact on successful outcome. Bowel rest did not influence outcome. Therefore nonoperative management of blunt extrahepatic bile duct blunt injuries in children should be based on ensuring adequate bile flow. Bowel rest does not seem to be a prerequisite for successful outcome. Index Word: Blunt abdominal trauma; extrahepatic bile duct injury; nonoperative.
Determinants of splenectomy in splenic injuries following blunt abdominal trauma
AA Akinkuolie, OO Lawal, OA Arowolo
South African Journal of Surgery , 2010,
Abstract: Introduction. The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic preservation. Patients and methods. Files of 55 patients managed for isolated splenic injuries from blunt abdominal trauma between 1998 and 2007 were retrospectively analysed using a pro forma. Management options were classified into nonoperative, operative salvage and splenectomy. Results. The majority of patients suffered splenic injury as a result of motor vehicle accident (MVA) trauma or falls. Splenectomy was undertaken in 33 (60%) patients, 12 (22%) had non-operative management, and operative salvage was achieved in 10 (18%) patients. Significant determinants of splenectomy were grade of splenic injury, hierarchy of the surgeon, and hierarchy of the assistant. Discussion. MVA injury and falls accounted for the vast majority of blunt abdominal trauma in this study. The rate and magnitude of energy transferred versus splenic protective mechanisms at the time of blunt abdominal trauma seems to determine the grade of splenic injury. Interest in splenic salvage surgery, availability of technology that enables splenic salvage surgery, and the experience of the surgeon and assistant appear to determine the surgical management. Conclusion. Legislation on vehicle safety and good parental control may reduce the severity of splenic injury in blunt abdominal trauma. When surgery is indicated, salvage surgery should be considered in intermediate isolated splenic injury to reduce the incidence of OPSI.
Subtle Radiological Features of Splenic Avulsion following Abdominal Trauma
S. A. Rehim,H. Dagash,P. P. Godbole,A. Raghavan,G. V. Murthi
Case Reports in Medicine , 2010, DOI: 10.1155/2010/762493
Abstract: Splenic trauma in children following blunt abdominal injury is usually treated by nonoperative management (NOM). Splenectomy following abdominal trauma is rare in children. NOM is successful as in the majority of instances the injury to the spleen is contained within its capsule or a localised haematoma. Rarely, the spleen may suffer from an avulsion injury that causes severe uncontrollable bleeding and necessitates an emergency laparotomy and splenectomy. We report two cases of children requiring splenectomy following severe blunt abdominal injury. In both instances emergency laparotomy was undertaken for uncontrollable bleeding despite resuscitation. The operating team was unaware of the precise source of bleeding preoperatively. Retrospective review of the computed tomography (CT) scans revealed subtle radiological features that indicate splenic avulsion. We wish to highlight these radiological features of splenic avulsion as they can help to focus management decisions regarding the need/timing for a laparotomy following blunt abdominal trauma in children.
The Incidence of Splenic Injury Following Blunt Abdominal Trauma (BAT), Sultan Qaboos University Hospital Experience  [PDF]
Abdullah Al-Busaidi, Tariq Al-Shafei, Huda Al-Moqbali, Sara Al-Kindi, Mohammed Al-Saadi, Nadya Al-Busaidi, Hani Al-Qadhi
Surgical Science (SS) , 2017, DOI: 10.4236/ss.2017.87034
Abstract: The aim of the study was to review traumatic splenic injury following blunt abdominal trauma (BAT), during the period from January 2009 to January 2015 at SQUH. The data for this study was retrospectively collected. It included 768 patients admitted to SQUH general surgery department following BAT. 43 patients with splenic injury were identified (34 males, 9 females). The mean age of patients with splenic injury was 36.0 years (34.4 years for males, 42.1 years for females). The most common mechanism of injury was motor vehicle collision (90.7%). Grade I, II are the most common grades of splenic injury. Non-Omani patients accounted for (51.2%) and most of them were pedestrians at the time of trauma. Ribs fracture is the most common injury associated with splenic injury. 36 (83.7%) patients were managed conservatively and 7 (16.3%) patients were splenectomized. Angioembolization was done for 11 (30.6%) patients. Despite the small population of Oman, high incidence of motor vehicle collision (MVC) increases the incidence of splenic injury among young age group.
Blunt trauma induced splenic blushes are not created equal
Clay Burlew, Lucy Z Kornblith, Ernest E Moore, Jeffrey L Johnson, Walter L Biffl
World Journal of Emergency Surgery , 2012, DOI: 10.1186/1749-7922-7-8
Abstract: During a 10-year period, we reviewed all patients transferred with blunt splenic injuries and contrast extravasation on initial postinjury CT scan.During the study period, 241 patients were referred for splenic injuries, of whom 16 had a contrast blush on initial CT imaging (88% men, mean age 35 ± 5, mean ISS 26 ± 3). Eight (50%) patients were managed without angioembolization or operation. Comparing patients with and without intervention, there was a significant difference in admission heart rate (106 ± 9 vs 83 ± 6) and decline in hematocrit following transfer (5.3 ± 2.0 vs 1.0 ± 0.3), but not in injury grade (3.9 ± 0.2 vs 3.5 ± 0.3), systolic blood pressure (125 ± 10 vs 115 ± 6), or age (38.5 ± 8.2 vs 30.9 ± 4.7). Of the 8 observed patients, 3 underwent repeat imaging immediately upon arrival with resolution of the blush. In the intervention group, 4 patients had ongoing extravasation on repeat imaging, 2 patients underwent empiric embolization, and 2 patients underwent splenectomy for physiologic indications.For blunt splenic trauma, evidence of contrast extravasation on initial CT imaging is not an absolute indication for intervention. A period of observation with repeat imaging could avoid costly, invasive interventions and their associated sequelae.A contrast blush on computed tomography (CT) scan has been identified as a risk factor for failure of nonoperative management (NOM) of splenic injuries [1-3], prompting many centers to perform routine splenic artery angioembolization in the presence of a blush [4,5]. Using evidence of contrast extravasation on CT scan as an indication for angioembolization, however, has never been subjected to rigorous analysis. In our experience, patients with splenic injuries transferred from other institutions specifically for angioembolization have often resolved the blush upon repeat imaging at our hospital. This made us question whether all postinjury splenic blushes were equivalent. Is evidence of contrast blush a mandate for
Nonoperative management for patients with grade IV blunt hepatic trauma  [cached]
Zago Thiago,Tavares Pereira Bruno,Araujo Calderan Thiago,Godinho Mauricio
World Journal of Emergency Surgery , 2012, DOI: 10.1186/1749-7922-7-s1-s8
Abstract: Introduction The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. Methods This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Results Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5%) who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%); one patient developed a tracheal stenosis (secondary to tracheal intubation); one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. Conclusions In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.
Laparoscopic treatment of biliary peritonitis following nonoperative management of blunt liver trauma
Ettore Marzano, Edoardo Rosso, Elie Oussoultzoglou, Olivier Collange, Philippe Bachellier, Patrick Pessaux
World Journal of Emergency Surgery , 2010, DOI: 10.1186/1749-7922-5-26
Abstract: A 28 years-old male was admitted in the Emergency Unit following a motor vehicle crash. CT-scan showed an isolated stade II hepatic injury at the level of the segment IV. Firstly a NOM was decided. Laparoscopic exploration was then performed at day 4 due to a biliary peritonitis. Intraoperative trans-cystic duct cholangiography showed a biliary leaks of left hepatic biliary tract, involving sectioral pedicle to segment III. Cholecystectomy, trans-cystic biliary drainage, application of surgical tissue sealing patch and abdominal drainage were performed. Postoperative outcome was uneventful, with fast patient recovery.Laparoscopy has gained a role as diagnostic and therapeutic means in treatment of complications following NOM of blunt liver trauma. This approach seems feasible and safety, with satisfactory postoperative outcome.Nowadays nonoperative management of blunt hepatic injuries is considered the treatment of choice in about 70% of cases. This attitude lead to appearance of otherwise unknown complications including bleeding, biliary, infectious and abdominal compartement syndrome. In selected cases, laparoscopy could be considered a valid option to treat these complications.Nonoperative management (NOM) of hemodynamically stable patients with blunt hepatic injuries is considered as the current standard of care [1,2]. Recent series reported that approximately 70% of patients with blunt liver injuries can be treated nonoperatively, with no hepatic-related mortality [3]. However, nonoperative treatment has been associated with several in-hospital complications, including bleeding, biliary, infectious and abdominal compartement syndrome. In this scenario, laparoscopy as gained a role as diagnostic and therapeutic means with favourable results [4,5]. Nevertheless, its application still remain under-proposed.A 28 years-old male was admitted in the Emergency Unit following a motor vehicle crash. The patient was hemodynamically stable (blood pressure = 110/70 mmHg; ca
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