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Splenic Injury

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2721. Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis. (Abstract)

Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis. Although splenic angioembolization (SAE) has been introduced and adopted in many trauma centers, the appropriate selection for and utility of SAE in trauma patients remains under debate. This study examined the outcomes of proximal SAE as part of a management algorithm for adult traumatic splenic injury compared with splenectomy.A retrospective cohort (...) analysis was performed on all hemodynamically stable (HDS) blunt trauma patients with isolated splenic injury and computed tomographic (CT) evidence of active contrast extravasation that presented to a level 1 Trauma Center over a period of 5 years. The cohorts were defined by two separate 30 month periods and included 78 patients seen before (group I) and 76 patients seen after (group II) the introduction of an institutional SAE protocol. Demographics, splenic injury grade, and outcomes of the two

2008 Journal of Trauma

2722. Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up. (Abstract)

Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up. To evaluate the clinical, US (ultrasound)-Doppler and hematologic findings after proximal splenic artery embolization (PSAE) for blunt injury.From August 1998 to February 2003, 37 patients (28 men and 9 women; 20-89 years old, mean 40 years) underwent PSAE for blunt injuries. One patient required secondary splenectomy after PSAE. Early complications were investigated during (...) complication was reported. Splenic measurements were in the normal range: length (53-110 mm; mean, 73), width (49-110 mm; 76), thickness (26-56 mm; 38), volume (61-508 mL; 226), standard ellipsoid formula volume (32-265 mL; 118), corrected volume (29-238 mL; 106), and splenic volumetric index (2.3-18.8; 8.4). The spleen was homogeneous in 23 patients (96%). Intrasplenic vascularization was present and splenic vein was patent in all patients. Howell-Jolly bodies were found in two patients. All patients (24

2007 Journal of Trauma

2723. Limitations of splenic angioembolization in treating blunt splenic injury. (Abstract)

Limitations of splenic angioembolization in treating blunt splenic injury. When angiography is performed in all hemodynamically normal patients with splenic injury, only 30% require embolization. This study examines the use of selective splenic angioembolization (SAE) as part of a management algorithm for adult splenic injury.Criteria for selective SAE were added to our adult splenic injury protocol in July 1999. SAE was performed in hemodynamically stable patients if computed tomographic (CT (...) to August 2003, 194 adults were treated for splenic injury. Nine patients underwent SAE, six for CT findings (1 vascular blush) and three for decreasing hematocrit. Three patients failed SAE (33%), one for bleeding and two for delayed splenic infarction. Eleven patients failed nonoperative therapy (8%); splenorrhaphy was performed in three and splenectomy in eight. Operative patients were more seriously injured and had higher Injury Severity Scores and mortality; splenectomy (39 of 48) was more commonly

2005 Journal of Trauma

2724. Evaluation of the degree of splenic injury by both CT and US in pediatric trauma victims. Full Text available with Trip Pro

Evaluation of the degree of splenic injury by both CT and US in pediatric trauma victims. 9563554 1998 05 07 2018 11 13 0003-4932 227 4 1998 Apr Annals of surgery Ann. Surg. Evaluation of the degree of splenic injury by both CT and US in pediatric trauma victims. 605 Thaler W W eng Letter Comment United States Ann Surg 0372354 0003-4932 AIM IM Ann Surg. 1997 Apr;225(4):408-14 9114800 Abdominal Injuries diagnostic imaging Child Humans Predictive Value of Tests Radiography, Abdominal Spleen (...) diagnostic imaging injuries Tomography, X-Ray Computed Ultrasonography Wounds, Nonpenetrating diagnostic imaging 1998 5 1 1998 5 1 0 1 1998 5 1 0 0 ppublish 9563554 PMC1191322 J Trauma. 1995 Sep;39(3):492-8; discussion 498-500 7473914 J Trauma. 1993 May;34(5):607-10; discussion 610-1 8496996 J Trauma. 1997 Apr;42(4):617-23; discussion 623-5 9137247 J Trauma. 1996 Jun;40(6):875-83; discussion 883-5 8656472 Ann Surg. 1997 Apr;225(4):408-14 9114800

1998 Annals of Surgery

2725. Splenic injury sustained from blunt abdominal trauma. Full Text available with Trip Pro

Splenic injury sustained from blunt abdominal trauma. 4073992 1985 12 30 2018 11 13 0003-4932 202 6 1985 Dec Annals of surgery Ann. Surg. Splenic injury sustained from blunt abdominal trauma. 788 Cooper M J MJ Williamson R C RC eng Letter United States Ann Surg 0372354 0003-4932 AIM IM Adolescent Adult Age Factors Female Humans Male Postoperative Complications Spleen injuries surgery Splenectomy Splenic Rupture surgery 1985 12 1 1985 12 1 0 1 1985 12 1 0 0 ppublish 4073992 PMC1251017 Br J Surg

1985 Annals of Surgery

2726. Splenic injuries. Full Text available with Trip Pro

Splenic injuries. 3069104 1989 05 10 2008 11 20 0264-4924 5 4 1988 Dec Archives of emergency medicine Arch Emerg Med Splenic injuries. 250 Reichl M M Wood T T Sleet R A RA eng Letter England Arch Emerg Med 8500828 0264-4924 IM Humans Spleen injuries Ultrasonography 1988 12 1 1988 12 1 0 1 1988 12 1 0 0 ppublish 3069104 PMC1285545

1988 Archives of Emergency Medicine

2727. Toward earlier diagnosis of splenic injury? Full Text available with Trip Pro

Toward earlier diagnosis of splenic injury? A series of patients who were found at operation to have sustained splenic rupture is described and their immediate presenting features are detailed. Signs of peritoneal irritation were not always present and patients were not often 'shocked' when first seen. Helpful early signs included a low haemoglobin and pallor. There is a tendency to underestimate the significance of left quadrant pain in the presence of rib fractures. Peritoneal lavage

1988 Archives of Emergency Medicine

2728. Argon beam coagulation is superior to conventional techniques in repair of experimental splenic injury. (Abstract)

Argon beam coagulation is superior to conventional techniques in repair of experimental splenic injury. Present management of splenic trauma focuses on splenic preservation. However, conventional operative techniques for splenic salvage are time consuming and frequently ineffective. The purpose of this study was to assess the efficacy of the argon beam coagulator (ABC) in the management of experimental splenic injury. Ten adult miniature pigs were randomized to treatment with either (...) conventional surgical techniques (topical Surgicel, electrocautery, suture-ligation, digital pressure) or splenic repair with the ABC. Three standard splenic injuries were made in each pig: capsular avulsion, splenic laceration, and hemisplenectomy. The ABC was more effective in treating all three types of splenic injury. The time required to achieve hemostasis and total operative time were significantly less in the group treated with the ABC for all three types of splenic injuries (p less than 0.05

1991 Journal of Trauma Controlled trial quality: uncertain

2729. Non-operative management of blunt splenic injury. Full Text available with Trip Pro

Non-operative management of blunt splenic injury. 1855039 1991 08 26 2018 11 13 0959-8138 302 6792 1991 Jun 29 BMJ (Clinical research ed.) BMJ Non-operative management of blunt splenic injury. 1553-4 Gibney E J EJ eng Editorial England BMJ 8900488 0959-8138 AIM IM BMJ. 1991 Jul 20;303(6795):188 1760011 Adult Child Humans Methods Spleen injuries Splenic Rupture therapy Wounds, Nonpenetrating therapy 1991 6 29 1991 6 29 0 1 1991 6 29 0 0 ppublish 1855039 PMC1670357 Bruns Beitr Klin Chir. 1964 Jun

1991 BMJ : British Medical Journal

2730. Management of injury to the spleen in adults. Results of early operation and observation. Full Text available with Trip Pro

Management of injury to the spleen in adults. Results of early operation and observation. Seventy-seven adults with splenic trauma were treated at a Level I Trauma Center during a 4-year period. Sixty-seven patients had early operation (55 splenectomy, nine splenorrhaphy, three partial splenectomy). Ten adults with stable vital signs were initially managed by observation without operation. Patients who had other intra-abdominal injuries were more likely to have an early operation (...) and splenectomy. Patients who had a lesser transfusion requirement were more likely to have initial nonoperative management. Only three of the 10 patients who were managed initially by observation avoided eventual operation. Six of the seven patients who failed observation management required splenectomy. Patients with isolated splenic injuries had a significantly shorter hospital stay after an early operation than after observation without operation (p less than 0.05). We recommend early operation

1984 Annals of Surgery

2731. Non-operative management of blunt splenic injury. Full Text available with Trip Pro

Non-operative management of blunt splenic injury. 1760011 1991 10 03 2018 11 13 0959-8138 303 6795 1991 Jul 20 BMJ (Clinical research ed.) BMJ Non-operative management of blunt splenic injury. 188 Fitzgerald R R eng Letter Comment England BMJ 8900488 0959-8138 AIM IM BMJ. 1991 Jun 29;302(6792):1553-4 1855039 Humans Spleen injuries Tomography, X-Ray Computed Wounds, Nonpenetrating diagnostic imaging 1991 7 20 1991 7 20 0 1 1991 7 20 0 0 ppublish 1760011 PMC1670409 BMJ. 1991 Jun 29;302(6792):1553

1991 BMJ : British Medical Journal

2732. Updating the management of salvageable splenic injury. Full Text available with Trip Pro

were life threatening and total splenectomy was performed. The other nine had major splenic trauma that was either an isolated phenomenon or was associated with an injury not jeopardizing survival; eight spleens were salvaged. Mean intra-abdominal blood loss was approximately 1250 mL and, using a "cell saver," an average of approximately 790 mL was reinfused. Six received no other blood transfusion whereas three received 2250 mL homologous blood in addition to 4250 mL via the "cell-saver (...) ." With hilar laceration, repair was facilitated by temporarily occluding the splenic pedicle atraumatically, and suturing torn polar branches via the laceration site. In both children and adults with major splenic injury, the authors now recommend early laparotomy with reinfusion of autologous blood. The spleen or a large remnant can usually be salvaged, and homologous blood transfusion with its attendant complication can often be obviated altogether.

1992 Annals of Surgery

2733. Experience with selective operative and nonoperative treatment of splenic injuries in 193 patients. Full Text available with Trip Pro

Experience with selective operative and nonoperative treatment of splenic injuries in 193 patients. During the past decade splenic salvage procedures rather than splenectomy have been considered the preferred treatment for traumatic splenic injuries. Splenic preservation has been most often accomplished by splenorrhaphy and more recently by a controversial nonoperative approach. This report delineates indications, contraindications, and results with splenectomy, splenorrhaphy, and nonoperative (...) treatment based on an 11-year experience (1978 to 1989) in which 193 consecutive adult patients with splenic injuries were treated. One hundred sixty-seven patients (86.5%) underwent urgent operation. Of these, 111 (66%) were treated by splenorrhaphy or partial splenectomy and 56 (34%) were treated by splenectomy. During the last 4 years, 26 additional patients (13.5%) were managed without operation. Patients considered for nonoperative treatment were alert, hemodynamically stable with computed

1990 Annals of Surgery

2734. Evaluation of splenic injury by computed tomography and its impact on treatment. Full Text available with Trip Pro

Evaluation of splenic injury by computed tomography and its impact on treatment. We reviewed 37 consecutive, hemodynamically stable patients (16 adults, 21 children) who had splenic injuries diagnosed by computed tomography (CT) scan to compare the CT evaluation with operative assessment of injury and eventual treatment. Computed tomographic scans and operative findings were graded by a splenic injury scoring system. Two patients were classified as having grade 1, 21 as grade 2, 11 as grade 3 (...) , and 3 as grade 4 splenic injuries. Computed tomography underestimated the degree of injury in 9 of 17 (53%) operated patients (mean CT score, 2.6; mean operative score, 3.3; p less than 0.01). Six of sixteen adults and 19 of 21 children were intentionally treated by observation. There were 5 treatments failures (20%), 3 due to bleeding and 1 each due to pancreatic injury and splenic abscess. The failure rate of observation was lower in children (16%) than in adults (33%), even though children had

1990 Annals of Surgery

2735. Nonoperative management of blunt hepatic and splenic injury in children. Full Text available with Trip Pro

Nonoperative management of blunt hepatic and splenic injury in children. The authors assessed the risks of nonoperative management of solid visceral injuries in children (age range, 4 months-14 years) who were consecutively admitted to a level I pediatric trauma center during a 6-year period ending in 1991.One hundred seventy-nine children (5.0%) sustained injury to the liver or spleen. Nineteen children (11.2%) died. Of the 160 children who survived, 4 received emergency laparotomies; 156 (...) underwent diagnostic computer tomography and were managed nonoperatively. The percentage of children who were successfully treated nonoperatively was 97.4%. Delayed diagnosis of enteric perforations occurred in two children. Fifty-three children (34.0%) received transfusions (mean volume 16.7 mL/kg); however, transfusion rates during the latter half of the study decreased from 50% to 19% in children with hepatic injuries, despite increasing grade of injury, and decreased from 57% to 23% in the splenic

1996 Annals of Surgery

2736. Management of splenic injuries in a Canadian trauma centre Full Text available with Trip Pro

Management of splenic injuries in a Canadian trauma centre To document the current practice pattern for the treatment of splenic injuries in one Canadian trauma centre and to identify factors that determined which method was employed.A cohort study.A Canadian lead trauma centre.A cohort of 100 patients with splenic injury treated at one trauma hospital over 5 years was identified from a prospective trauma database.The success rate and failure rate for splenic salvage by splenectomy (...) , splenorrhaphy or observation. Volume of blood transfused, injury severity score (ISS) and method of diagnosis.The median ISS for the cohort was 34 (36 for splenectomy, 38 for splenorrhaphy and 35 for observation). A blunt mechanism of injury was present in 96%. The diagnosis was made by computed tomography (CT) in 55%. Splenic salvage was accomplished in 51 patients; of these, 44 (86%) were in the observation group, and the success rate was 90% (within the range reported in the literature). Only seven

1996 Canadian Journal of Surgery

2737. Management outcomes in splenic injury: a statewide trauma center review. Full Text available with Trip Pro

Management outcomes in splenic injury: a statewide trauma center review. Clinical pathways now highlight both observation and operation as acceptable initial therapeutic options for the management of patients with splenic injury. The purpose of this study was to evaluate treatment trends for splenic injury in all North Carolina trauma centers over a 6-year period.Splenic injuries in adults over a 6-year period (January 1988-December 1993) were identified in the North Carolina Trauma Registry (...) using ICD-9-CM codes. Patients were divided into four groups by method of management: 1) no spleen operation, 2) splenectomy, 3) definitive splenorrhaphy, and 4) splenorrhaphy failure followed by splenectomy. The authors examined age, mechanism of injury, admitting blood pressure, and severity of injury by trauma score and injury severity score.Comparisons were made between adult (17-64 years of age) and geriatric (older than 65 years of age) patients and between patients with blunt and penetrating

1997 Annals of Surgery

2738. Occult splenic injury: delayed presentation manifesting as jaundice Full Text available with Trip Pro

Occult splenic injury: delayed presentation manifesting as jaundice Delayed splenic rupture, though uncommon, is a recognised clinical condition and is associated with a significant mortality rate. In the vast majority of cases the patient re-presents with abdominal symptoms and/or signs of acute intraperitoneal haemorrhage. A case is presented of delayed splenic rupture presenting with jaundice attributable to intra-abdominal clot lysis.

2001 Emergency Medicine Journal : EMJ

2739. Management of adult splenic injuries in Ontario: a population-based study Full Text available with Trip Pro

Management of adult splenic injuries in Ontario: a population-based study To determine the population-based incidence of splenic injuries in the Province of Ontario, the proportion of splenic injuries treated by observation, splenectomy and splenorrhaphy, changes in management over time and the variation in management of splenic injuries among Ontario hospitals.A retrospective cohort study.All adults (older than 16 years) admitted with a diagnosis of splenic injury (clinical modification (...) of the International Classification of Diseases, 9th revision) to acute care hospitals in Ontario between 1991 and 1994, identified from the Ontario Trauma Registry.The incidence of splenic injury was 1.7 cases per 1000 trauma admissions per year. Patients with splenic injury were young (median age 32 years) and male (71%), and the death rate was 8%. Observation was the commonest method of treatment (69%), followed by splenectomy (28%) and splenorrhaphy (4%). The use of observation increased over the study period

2000 Canadian Journal of Surgery

2740. Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline Full Text available with Trip Pro

Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline To review practice patterns in a Canadian pediatric centre and develop a safe and effective care plan for managing children with splenic injuries.A chart review.Winnipeg Children's Hospital.All patients with splenic injuries under the age of 17 years admitted to the hospital between December 1994 and April 1999.These included patient demographics, length of stay, location of care, grade of splenic (...) injury (American Association for the Surgery of Trauma Organ Injury Scale), imaging tests performed in hospital and after discharge, follow-up care and time to return to full activity.Forty-four patients received nonoperative management. The mean age of the patients was 10.4 years. The average grade of splenic injury was 2.8. Sixteen patients (36%) were admitted to the intensive care unit for an average of 1.9 days. Mobilization was allowed after a mean of 5.2 days. Average length of hospital stay

2002 Canadian Journal of Surgery

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