scholarly journals Modalities in the management of splenic trauma

2020 ◽  
Vol 7 (9) ◽  
pp. 2940
Author(s):  
Swetha B. M. ◽  
Santosh Raja Erabati ◽  
V. V. Harika Majji
Keyword(s):  
Conservative Management ◽  
Road Traffic ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Splenic Trauma ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Hemodynamic Status ◽  
Fall From Height ◽  
Non Operative Management

Background: The aim of the study to study the modalities in the management of splenic trauma. Factors affecting non operative management in order to improve the outcome of conservative management, and the factors responsible for conversion to operative management.Methods: 30 patients were admitted in the Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, satisfying the inclusion criteria between 01 June 2016 to 31 August 2018.Results: A cross-sectional type of study was performed. Among the 30 patients, 21 were male and 9 were female. It was seen that in 80% of patients the mode of injury was road traffic accident. Human assault, animal attack and fall from height contributed to 6.66% each. The most common reason for conversion to operative management was fragile hemodynamic status of the patient. 20% of the cases were grade I, 40% grade II, 26.66% grade III, 6.66% each of grade IV and grade V, all cases of grade IV and grade V were managed operatively. In this study 60% of the cases could be managed conservatively, 1 case (3.33%) splenorraphy was done. 33.3% (1/3rd) patients required splenectomy, and 1 (3.33%) patient expired who presented late and with hemodynamic instability, belonged to grade V splenic injury.Conclusions: Conservative management has replaced splenectomy as the most common method of splenic trauma management in patients with stable hemodynamic status. Higher grades of splenic injuries have been managed conservatively. As a result, 60% of all blunt splenic injuries can be managed non-operatively with a success rate of 98%. Operative management associated with stringent intensive care unit (ICU), transfusions are restricted to higher grades of splenic injuries.

scholarly journals A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma

2020 ◽  
Vol 7 (6) ◽  
pp. 1930
Author(s):  
Induchoodan Ponnamma Pillai Sukumaran Nair ◽  
Rajesh P. S.
Keyword(s):  
Abdominal Trauma ◽  
Conservative Management ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Road Traffic ◽  
Operative Management ◽  
Splenic Trauma ◽  
Solid Organ ◽  
Non Operative Management

Background: worldwide road traffic accidents accounts as the leading cause of death of young people. For a very long time most of the intra-abdominal injuries following blunt abdominal trauma were managed operatively. Conservative management is becoming more acceptable and effective management option for blunt abdominal trauma during the last few decades.Methods: This study was conducted in Government Medical College, Kottayam during September 2007 to December 2008. All conservatively managed blunt abdominal trauma patients during the study period were included in the study.Results: Out of 22 patients, 4 patients failed conservative management. Success rate was 81%. Most commonly injured solid organ in the study group was liver (77%). Maximum cases were of age group 10 to 20 (31.81%) years. 81% of patients were males. Motor vehicle accident was the most common cause of trauma (77%). Mean stay in intensive care unit was 4.2 days and mean hospital stay was 15.7 days. Mean systolic blood pressure was 110 mmHg ranging from 70 to 130 mmHg. 50% of patients had moderate hemoperitoneum and non-had massive hemoperitoneum.Conclusions: Non operative management is safe and effective approach in blunt spleen and liver injuries. Non operative management should be treatment of choice for all hemodynamically stable patients with blunt liver and splenic trauma.

scholarly journals Proportion of Cases Managed Non-Operatively and Its Predictors for Failure in Splenic Injury – A Cross Sectional Study from VSSIMSAR, Odisha

2021 ◽  
Vol 8 (17) ◽  
pp. 1116-1121
Author(s):  
Harekrishna Majhi ◽  
Abinasha Mohapatra ◽  
Sachin Paul James ◽  
Ashok Kumar Nayak
Keyword(s):  
Blood Pressure ◽  
Splenic Injury ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Cross Sectional Study ◽  
Primary Objective ◽  
Haemodynamic Instability ◽  
Sectional Study ◽  
Cross Sectional ◽  
Non Operative Management

BACKGROUND The primary objective in the management of splenic injury earlier was to achieve early haemostasis which resulted in splenectomy as the treatment of choice. But after recognising the role of spleen in immune and haematopoietic functions, nonoperative management (NOM) was started. In order to practice non-operative management safely a better way to assess the severity of splenic injury was necessary. Eventually it became possible with the advent of computed tomography. Along with clinical assessment, it enabled us in the selection of appropriate patients for non-operative management. Now this modality is considered as the gold standard for patients who are hemodynamically stable or readily stabilisable. It decreases the duration of hospital stay and prevents postoperative morbidity. We wanted to find out the proportion of cases and predictors for failure of non-operative management among splenic injury patients in VIMSAR, Burla. METHODS This cross-sectional study was done among 35 patients with splenic injury who were hemodynamically stable from November 2018 to October 2020. RESULTS Age, sex, systolic blood pressure, diastolic blood pressure, mechanism of injury, Glasgow Coma Score (GCS), associated injury (if hemodynamically stable) were not found to be significant predictors in deciding the failure of non-operative management. CONCLUSIONS Most important predictor for failure of non-operative management was development of haemodynamic instability. Tachycardia, low mean arterial pressure (MAP), drop in haemoglobin (Hb) and haematocrit were significant parameters in our study and all these parameters ultimately point towards hemodynamic instability. KEYWORDS Non-Operative Management (Successful), Non-Operative Management (Failure), Hemodynamically Stable, Blunt Trauma Abdomen

scholarly journals Non operative management of a patient with splenic trauma with angioembolisation after delayed presentation

2019 ◽  
Vol 6 (9) ◽  
pp. 3412
Author(s):  
Deepak Paul ◽  
Thomas K. Thomas ◽  
Dayananda Babu ◽  
Rajan Janardhanan ◽  
Ribin Christhudas
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Organ Injury ◽  
Splenic Trauma ◽  
Solid Organ ◽  
Delayed Presentation ◽  
Mortality And Morbidity ◽  
Common Causes ◽  
Non Operative Management

Road traffic accidents are one of the most common causes of death in India. Those involved in RTA’s frequently suffer from solid organ injury, spleen being the second most common organ involved. Splenic injuries are associated with great deal of mortality and morbidity. Splenic injuries were classically treated with splenectomy but there has been a paradigm shift to non-operative management in recent times leading to splenic salvage and preservation of function of the spleen. This report is about a lady who was managed successfully with angioembolization in spite of the fact that the patient presented late after RTA. 

scholarly journals Traumatic Liver Injury in Hong Kong: The Management Strategy and Outcome

2009 ◽  
Vol 16 (4) ◽  
pp. 208-216 ◽  
Author(s):  
CN Chong ◽  
YS Cheung ◽  
KF Lee ◽  
TH Rainer ◽  
BSP Lai
Keyword(s):  
Hong Kong ◽  
Liver Injury ◽  
Hospital Stay ◽  
Injury Severity ◽  
Road Traffic ◽  
Demographic Data ◽  
Operative Management ◽  
Concomitant Injuries ◽  
Significant Difference ◽  
Non Operative Management

Introduction Management of liver injury is challenging and evolving. The aim of this article is to review the outcome of traumatic liver injury in Chinese people in Hong Kong. Materials & methods Records of 40 patients with hepatic injury who received treatment at the Prince of Wales Hospital between December 2000 and May 2005 were reviewed. Demographic data, severity of liver injury, Injury Severity Score (ISS), haemodynamic status and Glasgow Coma Scale (GCS) score on admission, investigations made, concomitant injuries, management scheme, and outcome of patients were analysed. Results There were 23 male and 17 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (65%). Half of the patients were treated by non-operative management (NOM). None of them required surgery during subsequent management. Patients in the operative management (OM) group had a significantly higher ISS (p=0.026), but there was no significant difference in the mortality rate between the OM and NOM groups. Patients with stable haemodynamic status and who were treated non-operatively had a significantly shorter hospital stay (p=0.006). High grade liver injury (OR=8.0, 95% CI=1.2 to 53.8, p=0.03) and ISS greater than 25 (OR=21.6, 95% CI=2.0 to 225.3, p=0.01) were independent risk factors for mortality on multivariate analysis. Conclusions Non-operative management of liver injury can be safely accomplished in haemodynamically stable patients, with the possible benefit of a shorter hospital stay.

scholarly journals SPECTRUM AND OUTCOME OF BLUNT ABDOMINAL TRAUMA

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Mahesh Kumar Sharma ◽  
Dr. Arun Bhargava
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Traffic Accident ◽  
Traffic Accidents ◽  
Splenic Injury ◽  
Road Traffic ◽  
Age Groups ◽  
Operative Management ◽  
Fall From Height ◽  
Type Of Injury

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. So we evaluate the spectrum and outcome of blunt trauma. Methods: Hospital based prospective study conducted on 100 patients at department of general surgery. Results: Distribution according to type of injury consisted of maximum cases, 84 (84%) of road traffic accidents, 11% cases were of fall from height. Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt abdominal trauma, Liver injury, Perforation, Splenic injury

scholarly journals Solid organ injury in blunt trauma abdomen: an etiological evaluation and success rate of non-operative management

2018 ◽  
Vol 5 (4) ◽  
pp. 1350
Author(s):  
Ramachandra M. L. ◽  
Krishna S. R.
Keyword(s):  
Blunt Trauma ◽  
Surgical Management ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Abdominal Injury ◽  
Organ Injury ◽  
Free Fluid ◽  
Road Traffic Accidents ◽  
Non Operative Management

Background: Trauma remains the most common cause of death for all individuals between the ages of 1 and 44 years. 10% of these fatalities are attributable to abdominal injury. The Indian fatality rates for trauma are 20 times that for developed countries. The management of patients with blunt abdominal injury has evolved greatly over the last few decades from complete surgical management historically to present non operative management in most of the cases. In view of increasing number of road traffic accidents, rampant increase in construction work, accidental fall from height, this study is conducted to look into the causes of such incidents and also to strengthen the already established rules of non operative management in cases of blunt trauma abdomen.Methods: This is a prospective study of 53 patients who presented to K. R. Hospital, Mysuru, Karnataka, for management of blunt trauma abdomen over the period of January 2016 to June 2017. Unstable patients with initial resuscitation underwent Focused Assessment Sonography for Trauma. Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen. Organ injuries were scaled according to the American Association for the Surgery of Trauma and these patients were managed conservatively after ruling out hollow viscus perforation.Results: Majority of the patients belonged to male sex (85%) and of the age group 21-40 years constituting 58.3% of patients. Road traffic accident was the most common mode of injury which included 35 patients (66%). A total of 19 cases had splenic injury out of which 13 (68.5%) underwent non operative management and 6 (31%) underwent emergency Splenectomy. liver injury was present in 15 patients and all were managed conservatively. In total non operative management was done in 73.5% of cases and surgical management was done in 26.5% of cases.Conclusions: The presence of free fluid with organ injury always does not mandate laparotomy. Patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in non operative management of blunt trauma abdomen. RTA being the most common mode of injury, adequate measures should be taken to prevent road traffic accidents by strict action and traffic norms and citizen education.

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

2020 ◽  
Vol 44 (5) ◽  
pp. 1485-1491
Author(s):  
Matthew C. Hernandez ◽  
Michael D. Traynor ◽  
Ariel W. Knight ◽  
Victor Y. Kong ◽  
Grant L. Laing ◽  
...  
Keyword(s):  
South Africa ◽  
Operative Management ◽  
Splenic Trauma ◽  
Non Operative Management

scholarly journals An Experience with Management of Hemoperitoneum in Blunt Injury of Abdomen at Tertiary Care Center of Western Nepal

2019 ◽  
Vol 7 (1) ◽  
pp. 37-41
Author(s):  
Santosh Mishra ◽  
Kailash Chandra ◽  
Kumar Paudel
Keyword(s):  
Hospital Stay ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Management ◽  
Blunt Injury ◽  
Physical Assault ◽  
Non Operative Management

INTRODUCTION: Blunt abdominal trauma results in huge burden of morbidity and mortality among all age groups caused mainly by road traffic accident, fall from height and physical assault. This study was designed to evaluate the outcome of management of hemoperitoneum in blunt injury of abdomen. MATERIAL AND METHODS: This is a prospective observational study involving 100 cases of blunt abdominal injury during the period from 1st December, 2014 to 13th  March 2016 in UCMS-TH, Bhairahawa, Nepal. Documentation of the patients which included identification, history, clinical findings, diagnostic tests, operative findings, operative procedures, complications during hospital-stay was done. The decision regarding operative or non- operative management was made by specialist surgeon. RESULTS: The majority of the patients belonged to 21- 30 years age group. 72 cases were male while 28 were female. 93 patients were managed conservatively while 7 patients were operated. Most common mode of injury was road traffic accident (RTA) (74%) followed by fall form height (20%). Most common organ to be injured was spleen (65%) followed by liver (26%). 93 % patients underwent non-operative management while 7 % were operated. Mortality rate was 0% among the  non- operative and 14.29% in operative cases. CONCLUSION: Non operative management in patient with hemoperitoneum with regular monitoring of vitals and repeated clinical assessment can reduce the operative need , morbidity and length of hospital stay. Non-operative Management (NOM) for blunt abdominal injuries was found to be highly successful in 93% of the patients in this study.

Splenic injuries: factors affecting the outcome of non-operative management

2011 ◽  
Vol 38 (3) ◽  
pp. 269-274
Author(s):  
A. Böyük ◽  
M. Gümüş ◽  
A. Önder ◽  
M. Kapan ◽  
İ. Aliosmanoğlu ◽  
...  
Keyword(s):  
Operative Management ◽  
Factors Affecting ◽  
Non Operative Management
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