Blunt spleen injury is usually managed nonoperatively. An 8-year retrospective analysis by one community surgeon was done to provide an overview of the role of CT, angiography, and transfusion in the management algorithm. A total of 2750 patients were screened and 125 patients were identified with spleen injury. Of these 125 patients, 72 were managed without surgery. These were young (mean age 32 ± 16 years) patients with mean Injury Severity Score of 16 ± 8. Angiography was used in 14 patients. These patients received more blood (5 ± 6 vs 2 ± units of packed red blood cells) than their nonangiogram counterparts. Overall failure of nonoperative care was 3 per cent. Community surgeons can provide safe nonoperative care and current adjuncts including angi-ography may enhance splenic salvage.
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References
1.
PeitzmanA., RichardsonJ.D.Surgical treatment of injuries to the solid abdominal organs: a 50-year perspective from the Journal of Trauma.J Trauma2010; 69: 1011–21.
2.
ZarazurB.L., KozarK., MyersJ.G.The splenic injury outcomes trial. An American Association for the surgery of trauma: multi-institutional study.J Trauma Acute Care Surg2015; 79: 335–42.
3.
LeeperW.R., LeeperT.J., OuelletteD.Delayed hemorrhagic complications in nonoperative management of blunt splenic trauma: early screening leads to a decrease in failure rate.J Trauma Acute Care Surg2014; 76: 1349–53.
4.
GaarderC., DormagenJ.B., EkenT.Nonoperative management of splenic injuries.J Trauma2006; 61: 192–8.
5.
McIntyreL.K., SchiffM., JurkovichG.J.Failure of non-operative management of splenic injuries: causes and consequences.Arch Surg2005; 140: 563–9.
6.
SmithH.E., BifflW.L., MajercikS.D.Splenic artery embolization: have we gone too far?J Trauma2006; 61: 541–6.
7.
RequarthJ.A., D'AgostinaR.B., MillerP.R.Nonoperative management of adult blunt splenic injury with and without splenic artery embolotherapy: a meta-analysis.J Trauma2011; 71: 898–903.
8.
SkattumJ., NaessP.A., EkenT.Refining the role of splenic angiographic embolization in high-grade splenic injuries.J Trauma Acute Care Surg2013; 74: 100–4.
9.
BhullarI.S., FrykbergE.R., TepasJ.J.At first blush: absence of computed tomography contrast extravasation in Grade IV or V adult blunt splenic trauma should not preclude angioembolization.J Trauma Acute Care Surg2013; 74: 105–12.
10.
ZarzaurB.L., SavageS.A., CroceM.Trauma center angiography use in high grade blunt splenic injuries: timing is everything.J Trauma Acute Care Surg2014; 77: 666–72.
11.
BanerjeeA., DuaneT.M., WilsonS.P.Trauma center variation in splenic artery embolization and spleen salvage: a multicenter analysis.J Trauma Acute Care Surg2013; 75: 69–75.
12.
WeinbergJ.A., MagnottiL.J., CroceM.A.The utility of serial computed tomography imaging of blunt splenic injury: still worth a second look?J Trauma2007; 62: 1143–8.
13.
BowmanS.M., BulgerE., ShararS.R.Variability in pediatric splenic injury care results of a National Survey of General Surgeons.Arch Surg2010; 145: 1048–54.
14.
MooneyD.P., RothsteinD.H., ForbesP.W.Variation in the management of pediatric splenic injuries in the United States.J Trauma2006; 61: 330–3.
15.
StylianosS., EgorovaN., GuiceK.S.Variation in treatment of pediatric spleen injury at trauma centers versus non-trauma centers: a call for the dissemination of American Pediatric Surgical Association Benchmarks and Guidelines.J Am Coll Surg2006; 2: 247–51.
16.
McCrayV.W., DavisJ.W., LemasterD.Observation for nonoperative management of the spleen: how long is long enough?J Trauma2008; 65: 1354–8.
17.
East Trauma Practice Guidelines.2009. Non-operative management of blunt injury to the liver and spleen. Available at: http://www.east.org. Accessed April 4, 2010.
18.
BansalS., KarrerF.M., HansenK., PatrickD.A.Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization.Am J Surg2015; 210: 345–350.
19.
HebertP.C., WellG., BlajchnanM.A.A multicenter randomized, controlled, clinical trial of transfusion requirements in critical care.N Eng J Med1999; 340: 409–17.
20.
PluradP., MartinM., GreenD.Lung protective strategy with limited transfusion decreases risk of ARDS.J Trauma2007; 63: 1–7.
21.
ShorrA.F., DuhMei-Sheng, KellyK.M.Red blood cell transfusion and ventilator-associated pneumonia: a potential link?Crit Care Med2004; 32: 666–74.
22.
RobinsonW.P., AhnJ., StifflerA.Blood transfusion is an independent predictor of increased mortality in nonoperatively managed blunt hepatic and splenic injuries.J Trauma2005; 58: 437–45.
23.
HamlatC.A., ArbabiS., KoepsellT.D.National variation in outcomes and costs for splenic injury and the impact of trauma systems.Ann Surg2012; 255: 165–70.
