The best known splenic grading system is the one created by the american association for the surgery of trauma aast. The number of patients who did not require surgery increased from 70% to 87%, those requiring blood transfusion decreased from 36% to 23%, and the number undergoing a total splenectomy decreased from. The aim of this study was to describe the demographics, mechanisms of injury, management and outcomes in patients who su. Because children rarely exsanguinate from trauma to the spleen, splenectomy has been replaced by more conservative management as the treatment of. The spleen is one of the most frequently injured organs in blunt abdominal trauma. In the past decades, the treatment of patients with blunt splenic injury has. The value of injury grade in stratifying patients between operative and nom is not entirely reliable. In their invited critique, aidlen and luks suggest that rates of nonoperative management can be improved. Optimization of selection for nonoperative management of. Sep 01, 2007 nonoperative management has become the standard of care for hemodynamically stable children with splenic injury from blunt abdominal trauma. Nonoperative management of high grade splenic injury. Statement of the problem management of hepatic and splenic injuries has evolved over the past 25 years.
A diagnostic peritoneal lavage, while not ideal, may be used to evaluate the presence of internal bleeding a person who is hemodynamically unstable. Hemodynamically normal patient that has not required or has responded quickly to the resuscitation. At present, they are classified according to the anatomy of the injury. Unusual complications of colonoscopy include pneumothorax, septicemia, mesenteric tears, and colonic volvulus. Traumatic splenic injury and management spleniq study. Results most of the current guidelines support the nom or minimally approaches in hemodynamically stable patients.
Perforation is the next most common complication, with an incidence of 0. Treatment varies depending on severity, but often consists of embolism or splenectomy. As the use of colonoscopy has increased greatly in recent years, awareness of its complications has become more important. Two widely used embolization approaches are proximal and. Stable patients with lower grade injuries are treated conservatively.
Our primary objective was to compare clinical outcomes between operative and nonoperative manage ments in adult patients with blunt splenic injuries. Splenic rupture knowledge for medical students and. Pdf nonoperative management of high grade splenic injury. The approach for diagnosis and management of blunt splenic injury bsi has been considerably shifted towards nonoperative management nom. It is important that individuals who have been recently diagnosed with im meet with their doctor for clearance to return to sports. Santaniellos study states that 33% of the patients with blunt aortic injury have associated simultaneous hepatic splenic lesions. Splenic injury, blunt, selective nonoperative management of. One hundred fifty of 172 consecutive patients 87% with ctdiagnosed splenic injury were stable enough to be considered for nonoperative management. There are a few studies 34 nallathambi, malangoni, pickhardt, brick, mahon, taylor, jeffrey cit. Management of blunt splenic trauma pubmed central pmc. Splenic rupture is usually evaluated by fast ultrasound of the abdomen. Fernandes tm, dorigatti ae, pereira bmt, cruvinel neto j, zago tm, fraga gp. Splenic infarction and splenic vein thrombosis are rare causes of abdominal pain, usually presenting as leftsided abdominal pain associated with fever, nausea or vomiting, and elevated white blood cell count. Time of injury to splenic embolization in hours range options include.
Splenic rupture knowledge for medical students and physicians. All splenic injury grades had diagnostic angiography. Feb 22, 2012 the severity of splenic injury it appears that nom is effective in splenic injuries with an average lesional aast score of 3. Apr 04, 2017 traumatic splenic injury and management spleniq study spleniq the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Clinical and radiological presentations and management of blunt. The most accepted grading scale for splenic injury was established by the american association for the surgery of trauma in 1987 and revised in 1997 figure 1. Because children rarely exsanguinate from trauma to the spleen, splenectomy has been replaced by more conservative management as the. The extent to which this practice has been adopted in both trauma centers and nontrauma hospitals has been investigated sporadically. The primary symptom, hemorrhage, presents differently depending on the degree of injury, with the symptoms. Nonoperative management in blunt splenic trauma emergency. The department of pediatrics, bowman gray school of medicine of wake forest university, winstonsalem, north carolina modern technology, specifically the splenic scan, aids in a quick and accurate diagnosis of splenic injury. A rare mechanism of delayed splenic rupture following the nonoperative management of blunt splenic injury in a child toko shinkai, kentaro ono, kouji masumoto, yasuhisa urita and chikashi gotoh abstract background. However, there should be a predetermined transfusion threshold typically 2 units for isolated splenic injuries beyond which surgery should be done to prevent morbidity and mortality.
Practice management guidelines for the nonoperative management of blunt injury to the liver and spleen i. Management of spleen injuries in the adult trauma population. The trauma committee of the american pediatric surgical association apsa has established guidelines for inhospital observation, athome care, backtoschool criteria, and resumption of contact activity based on the grade of splenic. Nonoperative management has become the standard of care for the hemodynamically stable patient with a blunt splenic injury. Splenic injury is the leading cause of major bleeding in blunt abdominal trauma bat patients 1. Failure of nonoperative management of splenic injuries. Spleen injuries are among the most frequent traumarelated injuries. Up to 45% of patients with blunt abdominal trauma will have a splenic injury, 1 which may require urgent operative management, angioembolisation, or nonoperative management in the form of active observation. Traumatic splenic injury and management spleniq study spleniq the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The spleen is the most frequently injured solid organ following blunt abdominal trauma and it represents around 35% and sometimes up to 50% of all abdominal solid organ injuries. Medical management of grade 12 splenic injuries with active extravasation. Request pdf management of intraoperative splenic injury i ntraoperative splenic injury is reported to occur in approximately 0.
Blunt splenic trauma occurs when a significant impact to the spleen from some outside source i. Nonoperative management of splenic injury grade iv is safe using rigid protocol. Although their experience is rather limited involving 21 cases in 9 years january 1997 to december 2005, it reflects, to a great extent, the overall practice in the uk. This varies from institution to institution but usually includes patients with stable hemodynamic signs, stable hemoglobin levels over 1248 hours, minimal transfusion requirements 2 u or less, ct scan injury scale grade of 1 or 2 without a blush, and patients younger than 55 years. Bjui management of intraoperative splenic injury during. The spleen is top of the list of organs most injured in blunt trauma and, if the injury is unrecognized or not skill fully managed, the patient with splenic trauma can. The decision to attempt nonoperative management is largely determined by the splenic ct injury grade among other clinical factors, including. Hemorrhage is the most common complication, with an incidence of 12%. Several studies have demonstrated significant variations in practice patterns. Apr 03, 2017 the trend in management of splenic injury continues to favor nonoperative or conservative management. During this period of nonoperative management strict bed rest between 2472 hours with careful monitoring along with a ct 7 days after the injury.
We used the keywords traumatic splenic injury, blunt splenic trauma, management between december 1954 and november 2014. Objective to analyze national trends in the nonoperative management of pediatric splenic injury design retrospective cohort analysis patients all children and adolescents 18 years or younger from 2 national databases who were hospitalized with pediatric splenic injury setting data from 9 years of the national inpatient sample database 20002008 and 3 years of kids inpatient database. We read this article on the management of blunt splenic injury with interest. In rare cases, it may also be caused by spontaneous rupture from an infection or a hematological condition. Longterm outcome of nonoperative splenic injury management. Etiology and management of splenic infarction and splenic. Level ii trauma centers were no more likely to have a failure of nonoperative management adjusted or, 1. Management of isolated splenic injuries after blunt trauma. Nonoperative management of splenic injury can be considered when all of the following conditions have been met. Unstable patients undergo laparotomy and splenectomy.
A and b, portal venous phase a and renal excretory phase b axial maximumintensityprojection mdct images show active bleeding arrowheads into peritoneum from splenic injury. In general, the lower the injury grade the more likely. Splenic injury, blunt, selective nonoperative management. Recent nom protocols for splenic injuries debunk the removal of spleen from the equation myth.
American association for the surgery of trauma spleen injury scale. It includes recommendations for the management of blunt splenic injury in adult trauma pa tients based on literature available since. Trauma is a major cause of morbidity and mortality. The admitting hospitals trauma designation level was also associated with the risk of failure of nonoperative management of splenic injuries. Splenic arterial embolization has been proposed to reduce the risk of nonsurgical management failure in both adults and children. A retrospective study included all splenic injury patients admitted to christchurch public hospital between january 2005 and august 2015. Injury to the spleen is most often the result of blunt abdominal trauma. Management of intraoperative splenic injury request pdf. A rare mechanism of delayed splenic rupture following the. Selective nonoperative management of blunt splenic injury. Splenic trauma by doctor saleem linkedin slideshare.
The spleen is susceptible during trauma to the left lower thorax or left upper abdomen. Management of adult blunt splenic trauma2016 updates western. The spleen is the most commonly injured organ in blunt abdominal trauma. The spleen is the most easily injured organ in abdominal trauma. Wed like to understand how you use our websites in order to improve them. The trend in management of splenic injury continues to favor nonoperative or conservative management. This paper aims to provide an update on the treatments and dilemmas of nonoperative management of splenic injuries in adults and to offer suggestions that may improve both consensus and patient outcomes. Surgery is usually performed in patients who have traumatic injuries to. A ruptured spleen may result in massive intraabdominal bleeding and should therefore be treated as a medical emergency. Trends in operative management of pediatric splenic injury.
Review of proximal splenic artery embolization in blunt. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. Review of factors leading to high spleen slavage rate in a level 1 trauma centre. Two widely used embolization approaches are proximal and distal. Apr 11, 2009 splenic trauma,blunt trauma abdomen, spleen anatonmy ligaments blood supply accessory spleens, mechanism of injury, presentation symptoms and signs management operative vs non operative imaging techniques for spleen fast ct scan abdomen angiography, grades of splenic injury, criteria for non operative management, surgical management splenectomy vs splenorrahphy partial. Splenic injury due to infectious mononucleosis im often, an athlete returning to contact sports following infectious mononucleosis are at potential risk of splenic rupture secondary to abdominal trauma. The trauma committee of the american pediatric surgical association apsa has established guidelines for inhospital observation, athome care, backtoschool criteria, and resumption of contact activity based on the grade of splenic laceration as.
Abdominal pain is a common complaint among all ages of patients. Study type therapy case series level of evidence 4 objective to evaluate incidence, risk factors for, and management of intraoperative splenic injury in our laparoscopic patient cohort. Nonoperative management has become the standard of care for hemodynamically stable children with splenic injury from blunt abdominal trauma. The management of splenic injuries has evolved over the. Blunt aortic injuries accompany hepatic and splenic lesions in 1520% of cases fabian, hunt cit. Up to 45% of patients with blunt abdominal trauma will have a splenic injury,1 which may require urgent operative management, angioembolisation, or nonoperative management in the form of active observation. Ct promoted conservative management by defining the injury and excluding significant vascular or bowel injury. Selective nonoperative management of pediatric blunt splenic injury became the standard of care in the late 1980s. Listing a study does not mean it has been evaluated by the u. 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. To summarize their institutions experience over the past 50 years. Prospective trial of angiography and embolization for all grade iii to v blunt splenic injuries. Presentation and management of splenic injury after colonoscopy.
With the increasing use of colonoscopy, radiologists are more likely to encounter the unusual complications of this procedure. Further management of splenic injury depends on the haemodynamic stability of the patient splenic injury is graded i through v depending on the extent and depth of splenic haematoma andor laceration identified on computed tomography scan low grade splenic injuries i, ii, and iii are suitable for nonoperative management, although. The spleen is delivered to the midline by means of blunt and sharp dissection of the areolar plane between the kidney and the pancreas. The management of splenic injuries has evolved over. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Pdf presentation and management of splenic injury after.
Pdf spleen injuries are among the most frequent traumarelated injuries. Nonoperative management nom has been established as. An update on nonoperative management of the spleen in. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology. The effects of splenic artery embolization on nonoperative management of blunt splenic injury. With the spleen retracted medially, the phrenicocolic ligament is. An update on nonoperative management of the spleen in adults. Splenic preservation following trauma has been decisively established as the preferred, safe and feasible therapeutic modality. Many patients with blunt splenic injury are considered for nonoperative management and, with proper selection, the success rate is high. Splenic trauma,blunt trauma abdomen, spleen anatonmy ligaments blood supply accessory spleens, mechanism of injury, presentation symptoms and signs management operative vs non operative imaging techniques for spleen fast ct scan abdomen angiography, grades of splenic injury, criteria for non operative management, surgical management splenectomy vs. Non operative management can be adopted in majority of patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances. Tenyear experience of splenic trauma in new zealand.