Successful anesthetic management in a case of grade V splenic injury in covid 19 positive patient: A case report

2021 ◽  
Vol 8 (4) ◽  
pp. 49-53
Author(s):  
Anupama Kumari ◽  
Farah Husain ◽  
Anjili Sethi ◽  
Kirti Nath Saxena
Keyword(s):  
Case Report ◽  
Splenic Injury ◽  
Anesthetic Management ◽  
Exploratory Laparotomy ◽  
Anaesthetic Management ◽  
The Body ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Emergency Unit ◽  
Antigen Test

Splenic injuries are amongst the most frequent trauma-related injuries which requires emergency surgeries demanding meticulous surgical and anesthetic management. The aim while managing splenic trauma patients, is to restore homeostasis and normal pathophysiology in the body by achieving hemostasis with an emergency splenectomy. To date, there have been few reports describing the anaesthetic management of COVID-19 patients presenting for emergency surgery. In this article, we outline the anaesthetic management for a case with hemoperitoneum, posted for emergency exploratory laparotomy and splenectomy in our operating theatre who was incidentally diagnosed to be COVID positive in the emergency unit by a rapid antigen test.

scholarly journals Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes

2021 ◽  
Vol 38 (01) ◽  
pp. 105-112
Author(s):  
Majd Habash ◽  
Darrel Ceballos ◽  
Andrew J. Gunn
Keyword(s):  
Clinical Outcomes ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Operative Management ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
High Grade ◽  
Artery Embolization ◽  
Splenic Artery Embolization

AbstractThe spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.

scholarly journals Polytraumatic injury with splenic rupture and unilateral avascular renal necrosis: A case report

2017 ◽  
Vol 7 (1) ◽  
pp. 58-61
Author(s):  
Smit Shah ◽  
Praful Shah
Keyword(s):  
Public Health ◽  
Case Report ◽  
Splenic Injury ◽  
Motor Vehicle ◽  
Splenic Rupture ◽  
Treatment Plan ◽  
Standard Of Care ◽  
Exploratory Laparotomy ◽  
Colles Fracture ◽  
Renal Necrosis

In this paper, we present a patient who underwent an emergency exploratory laparotomy after Motor Vehicle Collison (MVC) leading to splenic injury, avascular necrosis of kidney and right upper extremity Colles’ fracture. Goal of the paper is to present a patient of polytrauma along with its treatment plan in terms of prioritizing the standard of care. We also discuss various radiographical findings along with gross surgical findings that were found intraoperatively.South East Asia Journal of Public Health Vol.7(1) 2017: 58-61

scholarly journals Pattern of injuries in trauma patients presenting in Accident and Emergency Department of Jinnah Hospital, Lahore

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Kamran Ali ◽  
Ghulam Mustafa Arain ◽  
Ahmad Sohail Masood ◽  
Aslam M
Keyword(s):  
Emergency Department ◽  
Upper Limb ◽  
Lower Limb ◽  
Tertiary Care ◽  
Age Groups ◽  
Exploratory Laparotomy ◽  
The Body ◽  
Trauma Patients ◽  
Accident And Emergency ◽  
Accident And Emergency Department

Objective: To observe the pattern of injuries in patients involved in different kinds of trauma presenting to the Accident and Emergency Department of Jinnah Hospital Lahore. Design: A prospective descriptive epidemiological study. Place and duration of study: Accident and emergency department of Jinnah Hospital Lahore. From 1st April 2005 to 30th September 2005. Subjects and methods: The study included patients presenting with different kinds of trauma to the emergency department of Jinnah Hospital, Lahore. They were further categorized into trauma of different regions of the body i.e. upper limb, lower limb, abdomen, head & neck, thorax and perineum. Then frequency of different types of trauma was determined. Results: During this period (1st April2005 to 30th September 2005), 111`413 patients presented in accident and emergency department and 4680 patients had traumatic injury. 1404 patients (30%) had blunt trauma, 134(2.86%) had penetrating firearms injury, 2433(51.99%) had penetrating sharp injury an d 709 patients (15.15%) had crush injury. Most patients got upper limb, lower limb, head & neck and abdominal injuries, in that order. Most patients received multiple injuries. 3340 patients (71.36%) got only minor surgery like stitching under local anaesthesia and 468 patients (10%) had no surgery at all. 872 patients (18.63%) underwent some kind of major surgical procedure like amputation, exploratory laparotomy, or stitching under GA etc. Conclusion: Trauma is a leading cause of morbidity and mortality among all age groups. Most of the trauma victims receiving minor injuries can be treated at primary heath care centers. This can decrease the load of tertiary care hospitals. Maximum impact in reducing the burden of trauma must come from injury prevention strategies.

scholarly journals Recent Changes in the Management of Blunt Splenic Injury: Effect on Splenic Trauma Patients and Hospital Implications

2008 ◽  
Vol 90 (2) ◽  
pp. 109-112 ◽  
Author(s):  
S Sinha ◽  
SVV Raja ◽  
MH Lewis
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Splenic Injury ◽  
Transfusion Requirement ◽  
Operative Management ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Blunt Splenic Injury ◽  
Non Operative Management

INTRODUCTION Management of blunt splenic injury has been controversial with an increasing trend towards splenic conservation. A retrospective study was performed to identify the effect of this changed policy on splenic trauma patients and its implications. PATIENTS AND METHODS Data regarding patient demography, mode of splenic injury, CT grading, blood transfusion requirement, operative findings hospital stay and follow-up were collected. Statistical analysis of the data was performed using non-parametric Mann–Whitney tests RESULTS Over an 8-year period, only 21 patients were admitted with blunt splenic injury. Ten patients were managed operatively and 11 non-operatively. Non-operative management failed in one patient due to continued bleeding. Using Buntain's CT grading, the majority of grades I and II splenic injuries were managed non-operatively and grades III and IV were managed operatively (P = 0.008). Blood transfusion requirement was significantly higher among the operative group (P = 0.004) but the non-operative group had a significantly longer hospital stay (P = 0.029). Among those managed non-operatively (median age, 24.5 years), a number of patients were followed up with CT scans with significant radiation exposure and unknown long-term consequences. CONCLUSIONS Non-operative management of blunt splenic trauma in adults can be performed with an acceptable outcome. Although CT is classed as the ‘gold standard’, initial imaging for detection and evaluation of blunt splenic injury, ultrasound can play a major role in follow-up imaging and potentially avoids major radiation exposure.

scholarly journals Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

2021 ◽  
Author(s):  
Arianna Birindelli ◽  
◽  
Matthew Martin ◽  
Mansoor Khan ◽  
Gaetano Gallo ◽  
...  
Keyword(s):  
Trauma Center ◽  
Laparoscopic Splenectomy ◽  
Splenic Injury ◽  
Laparoscopic Group ◽  
Bowel Function ◽  
Operative Management ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Intention To Treat ◽  
Operative Recovery

AbstractTechnique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidity.

Predictors of splenectomy after failure of non-operative management: An analysis of the nation trauma database from 2013 to 2014

Trauma ◽  
2020 ◽  
pp. 146040862091148
Author(s):  
Allan Nguyen ◽  
Alessandro Orlando ◽  
James R Yon ◽  
Caleb J Mentzer ◽  
Kaysie Banton ◽  
...  
Keyword(s):  
Splenic Injury ◽  
Functional Dependence ◽  
Data Bank ◽  
Operative Management ◽  
The Body ◽  
Splenic Trauma ◽  
Efficient Resource ◽  
Level I ◽  
Delay Of Care ◽  
Non Operative Management

Introduction There is practice variability in non-operative management (NOM) of blunt splenic trauma. This is particularly true for management decisions following failure of NOM, i.e. splenectomy versus angioembolization (AE). The objective of this study was to identify predictors of splenectomy versus AE in patients who failed NOM. Methods We included adult patients from the National Trauma Data Bank for 2013–2014, who had a splenic injury and who were admitted to a Level I Trauma Center (L1TC). Patients undergoing splenectomy after 2 h of emergency department arrival were deemed to have failed NOM. Multivariate logistic regression modeling was used to identify independent predictors of intervention after failed NOM. Results There were 2284 patients admitted for splenic injury between 2013 and 2014 who failed NOM. A total of 1253 patients underwent AE and 1031 patients underwent splenectomy. Seven independent factors were identified that predicted failure of NOM: penetrating injury, community L1TC, hospital bed size, number of trauma surgeons on call, functional dependence, chronic steroid use, and cirrhosis. Conclusions Seven independent variables were identified that predicted failure of NOM. These results contribute to the body of data regarding management of blunt splenic injury. Knowing predictive factors could help personalize management of patients, minimize delay of care, efficient resource allocation, and inform future studies.

Splenic Injury Due to Colonoscopy: Analysis of the World Literature, a New Case Report, and Recommendations for Management

2010 ◽  
Vol 76 (11) ◽  
pp. 1198-1204 ◽  
Author(s):  
Christopher P. Michetti ◽  
Emily Smeltzer ◽  
Samir M. Fakhry
Keyword(s):  
Case Report ◽  
World Literature ◽  
Splenic Injury ◽  
Case Reports ◽  
Rare Complication ◽  
Medical Attention ◽  
Splenic Trauma ◽  
Pubmed Database ◽  
Patient Reported ◽  
The World

Splenic injury is a rare complication of colonoscopy. Most literature on the topic is case-report based. Our objective was to perform a comprehensive analysis of characteristics of splenic injury due to colonoscopy from available published reports in the world literature, to compare and contrast this entity with that of traumatic splenic injury, and provide recommendations for management based on the analysis. We reviewed the PubMed database without restrictions using the terms splenic trauma after colonoscopy, splenic rupture from colonoscopy, splenic injury following colonoscopy, and splenic complications of colonoscopy, and also reviewed the references from the resulting publications. Retrieved manuscripts (case reports, reviews, and abstracts) were reviewed by two authors, and data extracted for 15 specific characteristics of each patient reported using a standardized data collection tool. Data were analyzed using descriptive statistics. Splenic injury due to colonoscopy is extremely rare as reported in published literature. The majority of patients that seek medical attention have delayed symptoms, and most require splenectomy. Subcapsular hematoma is the most common injury pattern seen. Selection criteria for operative management may be extrapolated from management guidelines for traumatic splenic injury, although nonoperative failure rates are higher for splenic injury due to colonoscopy than for trauma.

scholarly journals Emergency exploratory laparotomy in a COVID-19 patient - A case report -

2020 ◽  
Vol 15 (4) ◽  
pp. 498-504
Author(s):  
Seong Su Lee ◽  
Ji Hyun Park ◽  
Gunn Hee Kim ◽  
Mi Young Kwon ◽  
Hee Yeong Kim ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Case Report ◽  
High Efficiency ◽  
Anesthetic Management ◽  
Exploratory Laparotomy ◽  
Anesthesia Machine ◽  
Protective Equipment ◽  
Perforated Duodenal Ulcer ◽  
Risk Of Infection ◽  
Mechanically Ventilated

Background: Surgeries in patients with coronavirus disease 2019 (COVID-19) put medical staff at a high risk of infection. We report the anesthetic management and infection control of a mechanically ventilated COVID-19 patient who underwent exploratory laparotomy for suspected duodenal ulcer perforation.Case: A 73-year-old man, mechanically ventilated for confirmed COVID-19, showed clinical and radiographic signs of a perforated duodenal ulcer, and he was transferred under sedation and intubation to a negative-pressure operating room. The operating and assistant staff wore personal protective equipment. High-efficiency particulate absorbing (HEPA) filters were inserted into the expiratory circuits of the anesthesia machine and portable ventilator. No participating staff contracted COVID-19, although the patient later died due to pneumonia.Conclusions: This report can contribute to establishing clinical guidelines for the surgical management and operation room setting of COVID-19 patients.

Neonatal Gastric Web Located in the Body of Stomach: A Case Report

2006 ◽  
Vol 54 (1) ◽  
pp. 39
Author(s):  
Jun Hyun Yun ◽  
Hyun Jun Choi ◽  
Ji Hyeo Choi ◽  
Ju Hyun Im ◽  
Se Jong Kim ◽  
...  
Keyword(s):  
Case Report ◽  
The Body

Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

POCUS Journal ◽  
2016 ◽  
Vol 1 (3) ◽  
pp. 13-14
Author(s):  
Stuart Douglas, PGY4 ◽  
Joseph Newbigging, MD ◽  
David Robertson, MD
Keyword(s):  
Case Report ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Support ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Ultrasound Probe ◽  
Trauma Resuscitation ◽  
Highly Sensitive ◽  
Pouch Of Douglas

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

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