The surgical care of patients has evolved over the last 50 years. Operative intervention in the face of blunt spleen injury has been supplanted by non-operative techniques. Two of the newest techniques, angiography and embolisation, are reviewed in this article with references to patient selection, technique used and outcomes. Furthermore, current weaknesses in the data available are discussed in order to provide surgeons with a complete overview of the techniques.
Anderson JH, VuBan A., Wallace S., Hester JP, Burke JS1977. Transcatheter splenic arterial occlusion: an experimental study in dogs. Radiology125: 95-102.
2.
Bee TK, Croce MA, Miller PR, Pritchard FE, Davis KA, Fabian TC2001. Failures of splenic nonoperative management: is the glass half empty or half full? J Trauma50: 230-6.
Conti S.1980. Splenic artery ligation for trauma: an alternative to splenectomy. Am J Surg140: 444-6.
5.
Chuang VP, Reuter SR1975. Experimental diminution of splenic function by selective embolization of the splenic artery. Surg Gynecol Obstet140: 715-20.
6.
Clayer MTR, Drew PA, Leong As-Y, Jamieson GG1989. Regeneration and phogocytic function of devascularized spleens. Aust N Z J Surg59: 653-8.
7.
Cooney R., Ku J., Cherry R., Maish III GO , Carney D., Scorza LB, Smith JS2005. Limitations of splenic angioembolization in treating blunt splenic injury . J Trauma59: 926-32.
8.
Davis KA, Fabian TC, Croce MA, Gavant ML, Flick PA, Minard G., Kudsk KA, Pritchard FE1998. Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms. J Trauma44: 1008-15.
9.
Dent D., Alsabrook G., Erickson BA, Myers J., Wholey M., Stewart R., Root H., Ferral H., Postoak D., Napier D., Pruit Jr BA2004. Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization . J Trauma56: 1063-67.
10.
Diamond LK1969. Splenectomy in childhood and the hazard of overwhelming infection. Pediatrics43: 886-9.
11.
Ekeh AP, McCarthy MC, Woods RJ, Haley E.2005. Complications arising from splenic embolization after blunt splenic trauma. Am J Surg189: 335-9.
12.
Federle MP, Corucoulas AP, Powell M., Ferris JV, Peitzman AB1998. Blunt splenic injury in adults: clinical and CT criteria for management, with emphasis on active extravasation. Radiology206: 137-42.
13.
Feigenberg Z., Abramovici A., Zer M., Wolloch Y., Nathan H., Dintsman M.1985. Assessment of splenic function in dogs following arterial ligation and autotransplantation. J Med Sci21: 579-93.
14.
Gruber S., Redner B., Kogut B.1951. Congenital idiopathic thrombopenic purpura in a premature infant with splenectomy. New York Med51: 649-51.
15.
Haan J., Scott J., Boyd-Kranis RL, Ho S., Kramer M., Scales TM2001. Admission angiography for blunt splenic injury: advantages and pitfalls. J Trauma51: 1161-65.
16.
Haan JM, Biffl W., Knudson MM, Davis KA, Oka T., Majercik S., Dicker R., Marder S., Scalea TM2004. Splenic embolization revisited; a multi-center review . J Trauma56: 542-7.
17.
Haan JM, Bochicchio GV, Kramer N., Scalea TM2005. Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma58: 492-8.
18.
Haan JM, Marmery H., Shanmuganathan K., Mirvis SE, Scalea TM2007. Experience with splenic main coil embolization and significance of new or persistent pseudoaneurysm: reembolize, operate, or observe. J Trauma63: 615-9.
19.
Harbrecht BG, Ko SH, Watson GA, Forsythe RM, Rosengart MR, Peitzman AB2007b. Angiography for blunt splenic trauma does not improve the success rate of nonoperative management. J Trauma63: 44-9.
20.
Harbrecht BG, Zenati MS, Alarcon LH, Ochoa JB, Puyana JC, Schuchert VD, Peitzman AB2005. Is outcome after blunt splenic injury in adults better in high-volume trauma centers? Am Surg71: 942-9.
21.
Harbrecht BG, Zenati MS, Ochoa JB, Puyana JC, Alarcon LH, Peitzman AB2007a. Evaluation of a 15 year experience with splenic injuries in a state trauma system. Surgery141: 229-38.
22.
Harbrecht BG, Zenati MS, Ochoa JB, Townsend RN, Puyana JC, Wilson MA, Peitzman AB2004. Management of adult blunt splenic injuries: comparison between level I and Level II trauma centers. J Am Coll Surg198: 232-9.
23.
Horton J., Ogden ME, Williams S., Coln D.1982. The importance of splenic blood flow in clearing pneumococcal organisms. Ann Surg195: 172-6.
24.
Keramidas DC1979. The ligation of the splenic artery in the treatment of traumatic rupture of the spleen. Surgery85: 530-3.
25.
Keramidas DC, Soutis M.2003. The function of the spleen in adults after ligation of the splenic artery of the traumatized spleen in childhood. Surgery133: 583-5.
26.
Keramidas DC, Voyatzis N., Anagnostou D., Stavrides J., Koutoulides C., Ziros A.1980. Ligation of the splenic artery: effects on the injured spleen and its function. J Ped Surg15: 38-41.
27.
King H., Shumacker Jr HB1952. Splenic studies: I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg136: 239-42.
28.
Kohn JS, Clark DE, Isler RJ, Pope CF1994. Is computed tomographic grading of splenic injury useful in the nonsurgical management of blunt trauma? J Trauma36: 385-9.
29.
Liu PP, Lee WC, Cheng YF, Hsieh PM, Hsieh YM, Tan BL, Chen FC, Huang TC, Tung C.-C.2004. Use of splenic artery embolization as an adjunct to nonsurgical management of blunt splenic injury. J Trauma56: 768-73.
30.
Mirvis SE, Whitley NO, Gens DR1989. Blunt splenic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology171: 33-9.
31.
Nix JA, Costanza M., Daley BJ, Powell MA, Enderson BL2001. Outcome of the current management of splenic injuries . J Trauma50: 835-42.
32.
Nordlinger BM, Fulenwider JT, Millikan WJ, Warren WD1978. Splenic artery ligation in distal splenorenal shunts . Am J Surg136: 561-8.
33.
Omert LA, Salyer D., Dunham CM, Porter J., Silva A., Protetch J.2001. Implications of the ``contrast blush'' finding on computed tomographic scan of the spleen in trauma. J Trauma51: 272-8.
34.
Pabst R., Kamran D., Creutzig H.1984. Splenic regeneration and blood flow after ligation of the splenic artery or partial splenectomy. Am J Surg147: 382-6.
35.
Peitzman AB, Ford HR, Harbrecht BG, Potoka DA2001. Townsend RN. Injuries to the spleen. Cur Probl Surg12: 923-1008.
36.
Peitzman AB, Heil B., Riveria L.2000. Blunt splenic injury in adults: multi-institutional study of the Eastern Association for the Surgery of Trauma. J Trauma49: 177-89.
37.
Resciniti A., Fink MP, Raptopoulos V., Davidoff A., Silva WE1988. Nonoperative treatment of adult splenic trauma: development of a computed tomographic scoring system that detects appropriate candidates for expectant management. J Trauma28: 828-31.
38.
Richardson JD2005. Changes in the management of injuries to the liver and spleen. J Am Coll Surg200: 648-69.
39.
Schurr MJ, Fabian TC, Gavant M., Croce MA, Kudsk KA, Minard G., Woodman G., Pritchard FE1995. Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma39: 507-13.
40.
Schwalke MA, Crowley JP, Spencer P., Metzger J., Kawan M., Burchard KW1991. Splenic artery ligation for splenic salvage: clinical experience and immune function. J Trauma31: 385-8.
41.
Sclafani SJA.1981. The role angiographic hemostasis in salvage of the injured spleen. Radiology141: 645-50.
42.
Sclafani SJA, Shaftan GW, Scalea TM, Patterson LA, Kohl L., Kantor A., Herskowitz MM, Hoffer EK, Henry S., Dresner LS, Wetzel W.1995. Non-operative salvage of computed temographydiagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma39: 818-27.
43.
Sclafani SJA, Weisberg A., Scalea TM, Phillips TF, Duncan AO1991. Blunt splenic injuries: nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of the splenic artery . Radiology181: 189-96.
44.
Shanmuganathan K., Mirvis SE, Boyd-Kranis R., Takada T., Scalea TM2000. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology217: 75-82.
45.
Shapiro MJ, Krausz C., Durham RM, Mazuski JE1999. Overuse of splenic scoring and computed tomographic scans . J Trauma47: 651-8.
46.
Smith HE, Biffl WL, Majercik SD, Jednaoz J., Lambiase R., Cioffi WG2006. Splenic artery embolization: have we gone too far ? J Trauma61: 541-6.
47.
Sutyak JP, Chiu WC, D'Amelio LF, Amorosa JK, Hammond JS1995. Computed tomography is inaccurate in estimating the severity of adult splenic injury. J Trauma39: 514-8.
48.
Van Wyck DB, Witte MH, Witte CL, Strunk RC1978. Humoral immunity in experimental hyposplenism. Surgery84: 134-9.
49.
Villareal-Rios A., Mays ET1974. Efficacy of clinical evaluation and selective splenic arteriography in splenic trauma. Am J Surg127: 310-3.
Watson GA, Rosengart MR, Zenati MS, Tsung A., Forsythe RM, Peitzman AB, Harbrecht BG2006. Nonoperative management of severe blunt splenic injury: are we getting better? J Trauma61: 1113-19.
52.
Witte CL, Witte MH, Renert W., O'Mara RE, Lilien DL1976. Splenic artery ligation in selected patients with hepatic cirrhosis and in Sprague-dawley rats. Surg Gynecol Obstet142: 1-12.
