Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa

Management of abdominal trauma has evolved over the past decades and most of trauma patients can be managed conservatively. This article demonstrates the effectiveness of non-operative management (NOM) in a patient with grade IV renal trauma and grade II splenic trauma that was treated in the urology department of Emergency Clinical County Hospital of Brasov after a car crash. Clinical examination showed bruises on the right shoulder and macroscopic haematuria that suggest renal trauma. The abdomen was spontaneously painles, no signs of acute abdomen but severe pain in the left lumbar area, with no additional relevant medical history. The CT scan revealed laceration of the valvular area of the left kidney, spleen contusion and retroperitoneal haematoma with contrast spreading in the iliopsoas muscle region, classifying renal trauma as stage IV and splenic trauma as stage II on American Association for the Surgery of Trauma injury scale. The trauma is classified as serious with an Injury Severity Score of 18, and Resciniti CT score of 2, therefore NOM is recommended. Despite high grade trauma, the patient was haemodynamically stable, with a heart rate of 90 bpm, blood pressure of 105/65 mmHg and haemoglobin of 10.4g/dl. Under constant observation and with the help of a multidisciplinary team, the therapeutic focus was directed on local protocol consisting of pharmacological treatment with fluid resuscitation, antibiotic therapy, analgesics, haemostatics, anticoagulant therapy and multiple blood transfusions consisting of fresh frozen plasma and packed red blood cells. Starting with day 6, the haemoglobin levels normalized, no further blood transfusion beeing necessary. The patient was discharged and didn’t developed complications in the following 6 months. The NOM in the case of grade IV renal trauma and a grade II splenic trauma is effective, provided the patients are haemodynamically stable and constant reevaluations are performed.

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Damage control surgery for splenic trauma: "preserve an organ - preserve a life"

Colombia Medica ◽

10.25100/cm.v52i2.4794 ◽

2021 ◽

Vol 52 (2) ◽

pp. e4084794

Author(s):

Carlos Serna ◽

José Julian Serna ◽

Yaset Caicedo ◽

Natalia Padilla ◽

Linda M Gallego ◽

...

Keyword(s):

Damage Control ◽

Abdominal Cavity ◽

Damage Control Surgery ◽

Operative Management ◽

Splenic Trauma ◽

Severely Injured ◽

Severely Injured Patients ◽

Arterial Bleeding ◽

Non Operative Management ◽

Injured Patients

The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.

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Splenic artery embolisation in the non-operative management of blunt splenic trauma in adults

South African Journal of Radiology ◽

10.4102/sajr.v20i1.1014 ◽

2016 ◽

Vol 20 (1) ◽

Author(s):

Richard J. Cormack ◽

Mollie C.M. Ferris ◽

Jason K. Wong ◽

Stefan Przybojewski

Keyword(s):

Blunt Trauma ◽

Vascular Injury ◽

Splenic Artery ◽

Splenic Injury ◽

Operative Management ◽

Trauma Centre ◽

Splenic Trauma ◽

Non Operative Management ◽

Splenic Salvage ◽

Salvage Rate

Background: The purpose of this study was to evaluate the splenic salvage rate with angioembolisation in the non-operative management (NOM) of blunt splenic injury.Methods: We conducted a retrospective analysis of patients presenting to our Level I trauma centre with computed tomography (CT)-confirmed splenic injury following blunt trauma and in whom angioembolisation was utilised in the algorithm of NOM. Data review included CT and angiography findings, embolisation technique and patient outcomes.Results: Between January 2005 and April 2010, 60 patients with splenic injury following blunt trauma underwent NOM, which included splenic artery embolisation (SAE). All patients included in the study required a preadmission. CT scan was used to document the American Association for the Surgery of Trauma (AAST) grade of splenic injury. The average injury grade was 3.0. The non-operative splenic salvage rate following SAE was 96.7% with statistically similar salvage rates achieved for grades II to IV injuries. The quantity of haemoperitoneum and the presence of a splenic vascular injury did not significantly affect the splenic salvage rate. The overall complication rate was 27%, of which 15% were minor and 13% were major.Conclusion: SAE is a safe and effective treatment strategy in the NOM of blunt splenic injury. The quantity of haemoperitoneum, the presence of vascular injury and embolisation technique did not significantly affect the splenic salvage rate.

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Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-015-0575-z ◽

2015 ◽

Vol 42 (5) ◽

pp. 593-598 ◽

Cited By ~ 16

Author(s):

A. Brillantino ◽

F. Iacobellis ◽

U. Robustelli ◽

E. Villamaina ◽

F. Maglione ◽

...

Keyword(s):

Treatment Protocol ◽

Operative Management ◽

Splenic Trauma ◽

Prospective Evaluation ◽

Standardized Treatment ◽

Blunt Splenic Trauma ◽

Non Operative Management

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Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives

Surgery Today ◽

10.1007/s00595-020-02177-2 ◽

2020 ◽

Author(s):

Luigi Romeo ◽

Francesco Bagolini ◽

Silvia Ferro ◽

Matteo Chiozza ◽

Serafino Marino ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Splenic Injury ◽

Nonoperative Management ◽

Current Knowledge ◽

Operative Management ◽

Current Status ◽

Splenic Trauma ◽

Future Perspectives ◽

Encapsulated Bacteria ◽

Non Operative Management

AbstractThe spleen is one of the organs most commonly injured by blunt abdominal trauma. It plays an important role in immune response to infections, especially those sustained by encapsulated bacteria. Nonoperative management (NOM), comprising clinical and radiological observation with or without angioembolization, is the treatment of choice for traumatic splenic injury in patients who are hemodynamically stable. However, this strategy carries a risk of failure, especially for high-grade injuries. No clear predictors of failure have been identified, but minimally invasive surgery for splenic injury is gaining popularity. Laparoscopic surgery has been proposed as an alternative to open surgery for hemodynamically stable patients who require surgery, such as after failed NOM. We reviewed research articles on laparoscopic surgery for hemodynamically stable patients with splenic trauma to explore the current knowledge about this topic. After presenting an overview of the treatments for splenic trauma and the immunological function of the spleen, we try to identify the future indications for laparoscopic surgery in the era of NOM.

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