A Brillantino1, F Iacobellis2, U Robustelli3, E Villamaina3, F Maglione4, O Colletti3, M De Palma3, F Paladino5, G Noschese3. 1. Emergency Department, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy. antonio_brillantino@libero.it. 2. Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy. 3. Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy. 4. Department of Radiology, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy. 5. Emergency Department, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
Abstract
PURPOSE: The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. METHODS: All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. RESULTS: 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. CONCLUSIONS: The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.
PURPOSE: The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. METHODS: All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. RESULTS: 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. CONCLUSIONS: The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.
Authors: A B Peitzman; B Heil; L Rivera; M B Federle; B G Harbrecht; K D Clancy; M Croce; B L Enderson; J A Morris; D Shatz; J W Meredith; J B Ochoa; S M Fakhry; J G Cushman; J P Minei; M McCarthy; F A Luchette; R Townsend; G Tinkoff; E F Block; S Ross; E R Frykberg; R M Bell; F Davis; L Weireter; M B Shapiro Journal: J Trauma Date: 2000-08
Authors: Daniel Dent; Grady Alsabrook; Brian A Erickson; John Myers; Michael Wholey; Ronald Stewart; Harlan Root; Hector Ferral; Darren Postoak; Dacia Napier; Basil A Pruitt Journal: J Trauma Date: 2004-05
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Authors: Mariano Scaglione; Raffaella Basilico; Andrea Delli Pizzi; Francesca Iacobellis; Elizabeth Dick; Stefan Wirth; Ulrich Linsenmaier; Cem Calli; Ferco H Berger; Koenraad H Nieboer; Ana Blanco Barrio; Maureen Dumba; Roberto Grassi; Katarzyna Katulska; Gerd Schueller; Michael N Patlas; Andrea Laghi; Mario Muto; Refky Nicola; Marc Zins; Vittorio Miele; Richard Hartley; Douglas S Katz; Lorenzo Derchi Journal: Eur Radiol Date: 2020-11-05 Impact factor: 5.315
Authors: Federico Coccolini; Giulia Montori; Fausto Catena; Yoram Kluger; Walter Biffl; Ernest E Moore; Viktor Reva; Camilla Bing; Miklosh Bala; Paola Fugazzola; Hany Bahouth; Ingo Marzi; George Velmahos; Rao Ivatury; Kjetil Soreide; Tal Horer; Richard Ten Broek; Bruno M Pereira; Gustavo P Fraga; Kenji Inaba; Joseph Kashuk; Neil Parry; Peter T Masiakos; Konstantinos S Mylonas; Andrew Kirkpatrick; Fikri Abu-Zidan; Carlos Augusto Gomes; Simone Vasilij Benatti; Noel Naidoo; Francesco Salvetti; Stefano Maccatrozzo; Vanni Agnoletti; Emiliano Gamberini; Leonardo Solaini; Antonio Costanzo; Andrea Celotti; Matteo Tomasoni; Vladimir Khokha; Catherine Arvieux; Lena Napolitano; Lauri Handolin; Michele Pisano; Stefano Magnone; David A Spain; Marc de Moya; Kimberly A Davis; Nicola De Angelis; Ari Leppaniemi; Paula Ferrada; Rifat Latifi; David Costa Navarro; Yashuiro Otomo; Raul Coimbra; Ronald V Maier; Frederick Moore; Sandro Rizoli; Boris Sakakushev; Joseph M Galante; Osvaldo Chiara; Stefania Cimbanassi; Alain Chichom Mefire; Dieter Weber; Marco Ceresoli; Andrew B Peitzman; Liban Wehlie; Massimo Sartelli; Salomone Di Saverio; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-08-18 Impact factor: 5.469