nach oben

European Journal of Trauma and Emergency Surgery

Erschienen in:

28.09.2015 | Original Article

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

verfasst von: A. Brillantino, F. Iacobellis, U. Robustelli, E. Villamaina, F. Maglione, O. Colletti, M. De Palma, F. Paladino, G. Noschese

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 5/2016

Einloggen, um Zugang zu erhalten

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.

Gaines BA. Intra-abdominal solid organ injury in children: diagnosis and treatment. J Trauma. 2009;67:S135–9.CrossRefPubMed

Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA. Pons PT epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38(2):185–93.CrossRefPubMed

Smith J, Caldwell E, D’Amours S, Jalaludin B, Sugrue M. Abdominal trauma: a disease in evolution. ANZ J Surg. 2005;75(9):790–4.CrossRefPubMed

Hancock GE, Farquharson AL. Management of splenic injury. J R Army Med Corps. 2012;158(4):288–98.CrossRefPubMed

Dupuy DE, Raptopoulos V, Fink MP. Current concepts in splenic trauma. J Intensive Care Med. 1995;10(2):76–90.CrossRefPubMed

Akinkuole AA, Lawal OO, Arowolo OA, Agbakwuru EA, Adesunkanmi ARK. Determinants of splenectomy in splenic injuries following blunt abdominal trauma. S Afr J Surg. 2010;48(1):15–9.

Costa G, Tierno SM, Tomassini F, Venturini L, Frezza B, Cancrini G, Stella F. The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry. Ann Ital Chir. 2010;81:95–102.PubMed

van der Vlies CH, Hoekstra J, Ponsen KJ, Reekers JA, van Delden OM, Goslings JC. Impact of splenic artery embolization on the success rate of nonoperative management for blunt splenic injury. Cardiovasc Intervent Radiol. 2012;35:76–81.CrossRefPubMed

Cirocchi R, Corsi A, Castellani E, Barberini F, Renzi C, Cagini L, Boselli C, Noya G. Case series of non-operative management vs. operative management of splenic injury after blunt trauma. Ulus Travma Acil Cerrahi Derg. 2014;20(2):91–6. doi:10.5505/tjtes.2014.99442.CrossRefPubMed

10.

Shakford SR, Molin MR. Management of splenic injuries. Surg Clin North Am. 1990;70:595–620.CrossRef

11.

Pachter HL, Guth AA, Hofstetter SR, Spencer FC. Changing patterns in the management of splenic trauma. Ann Surg. 1998;227:708–19.CrossRefPubMedPubMedCentral

12.

Clancy AA, Tiruta C, Ashman D, Ball CG, Kirkpatrick AW. The song remains the same although the instruments are changing: complications following selective nonoperative management of blunt spleen trauma: a retrospective review of patients at a level I trauma centre from 1996 to 2007. J Trauma Manag Outcomes. 2012;6:4.CrossRefPubMedPubMedCentral

13.

Cirocchi R, Boselli C, Corsi A, Farinella E, Listorti C, Trastulli S, Renzi C, Desiderio J, Santoro A, Cagini L, Parisi A, Redler A, Noya G, Fingerhut A. Is non-operative management safe and effective for all splenic blunt trauma? A systematic review. Crit Care. 2013;17(5):R185. doi:10.1186/cc12868.CrossRefPubMedPubMedCentral

14.

Dent D, Alsabrook G, Erickson BA, Myers J, Wholey M, Stewart R, Root H, Ferral H, Postoak D, Napier D, Pruitt BA Jr. Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization. J Trauma. 2004;56:1063–7.CrossRefPubMed

15.

Gaarder C, Dormagen JB, Eken T, Skaga NO, Klow NE, Pillgram-Larsen J, Buanes T, Naess PA. Nonoperative management of splenic injuries: improved results with angioembolization. J Trauma. 2006;61:192–8.CrossRefPubMed

16.

Malhotra AK, Carter RF, Lebman DA, Carter DS, Riaz OJ, Aboutanos MB, Duane TM, Ivatury RR. Preservation of splenic immunocompetence after splenic artery angioembolization for blunt splenic injury. J Trauma. 2010;69:1126–30.CrossRefPubMed

17.

Franklin GA, Casós SR. Current advances in the surgical approach to abdominal trauma. Injury. 2006;37:1143–56.CrossRefPubMed

18.

Fu CY, Wu SC, Chen RJ, Chen YF, Wang YC, Huang HC, Huang JC, Lu CW, Lin WC. Evaluation of need for operative intervention in blunt splenic injury: intraperitoneal contrast extravasation has an increased probability of requiring operative intervention. World J Surg. 2010;34:2745–51.CrossRefPubMed

19.

Williams MD, Young DH, Svhiller WR. Trand toward nonoperative management of splenic injuries. Am J Surg. 1990;160:588–93.CrossRefPubMed

20.

Nakae H, Shimazu T, Miyauchi H, Morozumi J, Ohta S, Yamaguchi Y, Kishikawa M, Ueyama M, Kitano M, Ikeuchi H, Yukioka T, Sugimoto H. Does splenic preservation treatment (embolization, splenorrhaphy, and partial splenectomy) improve immunologic function and long-term prognosis after splenic injury? J Trauma. 2009;67:557–63.CrossRefPubMed

21.

Skattum J, Naess PA, Gaarder C. Non-operative management and immune function after splenic injury. Br J Surg. 2012;99(Suppl 1):59–65.CrossRefPubMed

22.

Scaglione M, de Lutio di Castelguidone E, Scialpi M, Merola S, Diettrich AI, Lombardo P, Romano L, Grassi R. Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process? Eur J Radiol. 2004;50(1):67–73.CrossRefPubMed

23.

Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38:323–4.CrossRefPubMed

24.

Greenspan L, McLellan BA, Greig H. Abbreviated injury scale and injury severity score: a scoring chart. J Trauma. 1985;25:60–4.CrossRefPubMed

25.

Advanced Trauma Life Support^®—ATLS^®—Student Manual. 9th ed. American College of Surgeon. ISBN: 978-1880696026.

26.

Haan JM, Bochicchio GV, Kramer N, Scalea TM. Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma. 2005;58(3):492–8.CrossRefPubMed

27.

Pietzman AB, Heil B, Rivera L, et al. Blunt splenic injury in adults: multi-institutional study of the eastern association for the surgery of Trauma. J Trauma. 2000;49(2):177–89.CrossRef

28.

Bhangu A, Nepogodiev D, Lal N, Bowley DM. Meta-analysis of predictive factors and outcomes for failure of non-operative management of blunt splenic trauma. Injury. 2012;43(9):1337–46. doi:10.1016/j.injury.2011.09.010.CrossRefPubMed

29.

Bouglé A, Harrois A, Duranteau J. Resuscitative strategies in traumatic hemorrhagic shock. Ann Intensive Care. 2013;3(1):1. doi:10.1186/2110-5820-3-1.CrossRefPubMedPubMedCentral

30.

Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care. 2013;17(2):R76. doi:10.1186/cc1268.CrossRefPubMedPubMedCentral

31.

Gheju I, Venter MD, Beuran M, Gulie L, Racoveanu I, Carstea P, et al. Grade IV blunt splenic injury—the role of proximal angioembolization. A case report and review of literature. J Med Life. 2013;6(4):369–75.PubMedPubMedCentral

32.

Olthof DC, van der Vlies CH, Joosse P, van Delden OM, Jurkovich GJ, Goslings JC; PYTHIA Collaboration Group. Consensus strategies for the nonoperative management of patients with blunt splenic injury: a Delphi study. J Trauma Acute Care Surg. 2013;74(6):1567–74. doi:10.1097/TA.0b013e3182921627.CrossRefPubMed

33.

Bhullar IS, Frykberg ER, Tepas JJ 3rd, Siragusa D, Loper T, Kerwin AJ. At first blush: absence of computed tomography contrast extravasation in Grade IV or V adult blunt splenic trauma should not preclude angioembolization. J Trauma Acute Care Surg. 2013;74(1):105–11. doi:10.1097/TA.0b013e3182788cd2.CrossRefPubMed

34.

Dormagen J, Meyerdierks O, Gaarder C, Naess P, Sandvik L, Klow NE. Contrast-enhanced ultrasound of the injured spleen after embolization–comparison with computed tomography. Ultraschall Med. 2011;32(5):485–91. doi:10.1055/s-0029-1246003.CrossRefPubMed

Titel: Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol
verfasst von: A. Brillantino
F. Iacobellis
U. Robustelli
E. Villamaina
F. Maglione
O. Colletti
M. De Palma
F. Paladino
G. Noschese
Publikationsdatum: 28.09.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 5/2016
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-015-0575-z

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2016

Focus on co-management in geriatric fracture care

Management of malnutrition in geriatric trauma patients: results of a nationwide survey

A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review

Cemented hip hemiarthroplasty clinical observations on unstable intertrochanteric fracture in elderlies

Assessing bicycle-related trauma using the biomarker S100B reveals a correlation with total injury severity