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Distal embolization versus combined embolization techniques for blunt splenicinjuries: comparison of the efficacy and complications Comparable failure rates of distal or proximal transcatheter arterial embolization (TAE) techniques for blunt splenicinjuries have been reported. This study is to investigate the efficacy and complication of combining both TAE techniques. We included 26 patients of blunt splenicinjuries for TAE therapy and randomized them into distal TAE and combined TAE groups (...) . They were considered failures in distal TAE group as opposed to all successes in combined TAE group. The risk difference of failure of distal TAE was 17.6%. None developed post-TAE splenic abscess, massive splenic infarct or pancreatitis. The mean splenic infarct volume of distal TAE (10.9%) versus combined TAE groups (6.6%) was not significant (p = 0.481). Combined TAE is effective and safe to decrease the failure rates of non-operative management for blunt splenicinjuries.
Splenic glucocorticoid resistance following psychosocial stress requires physical injury Mice exposed to chronic subordinate colony housing (CSC) stress show glucocorticoid (GC) resistance of in vitro lipopolysaccharide (LPS)-stimulated splenocytes, increased anxiety and colitis. Similar effects were reported in wounded mice exposed to social disruption (SDR). Here we show that CSC exposure induced GC resistance in isolated and in vitro LPS-stimulated, but not unstimulated, splenocytes (...) , and these effects were absent when CD11b+ splenocytes were depleted. Moreover, re-active coping behaviour during CSC correlated with the attacks and bites received by the resident, which in turn highly correlated with the dimension of splenic GC resistance, as with basal and LPS-induced in vitro splenocyte viability. Importantly, social stress promoted spleen cell activation, independent of bite wounds or CD11b+/CD11b- cell phenotype, whereas GC resistance was dependent on both bite wounds and the presence
How Does the Severity of Injury Vary between Motorcycle and Automobile Accident Victims Who Sustain High-Grade Blunt Hepatic and/or SplenicInjuries? Results of a Retrospective Analysis High-grade blunt hepatic and/or splenicinjuries (BHSI) remain a great challenge for trauma surgeons. The main aim of this study was to investigate the characteristics, mortality rates, and outcomes of high-grade BHSI in motorcyclists and car occupants hospitalized for treatment of traumatic injuries in a Level (...) I trauma center in southern Taiwan.High-grade BHSI are defined as grade III-VI blunt hepatic injuries and grade III-V blunt splenicinjuries. This retrospective study reviewed the data of 101 motorcyclists and 32 car occupants who experienced a high-grade BHSI from 1 January 2011 to 31 December 2013. Two-sided Fisher's exact or Pearson's chi-square tests were used to compare categorical data, unpaired Student's t-test was used to analyze normally distributed continuous data, and Mann-Whitney's U
SplenicInjury, Blunt, Selective Nonoperative Management of SplenicInjury, Blunt, Selective Nonoperative Management of - Practice Management Guideline Search » SplenicInjury, Blunt, Selective Nonoperative Management of Published 2012 Citation: Authors Stassen, Nicole A. MD; Bhullar, Indermeet MD; Cheng, Julius D. MD; Crandall, Marie L. MD; Friese, Randall S. MD; Guillamondegui, Oscar D. MD; Jawa, Randeep S. MD; Maung, Adrian A. MD; Rohs, Thomas J. Jr MD; Sangosanya, Ayodele MD; Schuster (...) in mortality of these injuries.  Pachter et al.,  in 1998, showed that 65% of all blunt splenicinjuries and could be managed nonoperatively with minimal transfusions, morbidity, or mortality, with a success rate of 98%. These issues were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the Practice Management Guidelines for Non-operative Management of Blunt Injury to the Liver and Spleen published online in 2003.  Since that time, a large volume of literature
Non-operative management for penetrating splenic trauma: how far can we go to save splenic function? Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenicinjury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim of this study was to investigate the outcome of selective NOM for penetrating splenic injuries.A dual-centre
Iatrogenic splenicinjury: review of the literature and medico-legal issues Iatrogenic splenicinjury is a recognized complication in abdominal surgery. The aim of this paper is to understand the medico-legal issues of iatrogenic splenicinjuries. We performed a literature review on PubMed and Scopus using iatrogenic splenic or spleen injury and iatrogenic splenic rupture as keywords. Iatrogenic splenicinjury cases were identified. Most cases were related to colonoscopy, but we also identified (...) cases related to upper gastrointestinal procedures, colonic surgery, ERCP, left nephrectomy and/or adrenalectomy, percutaneous nephrolithotomy, vascular operations involving the abdominal aorta, gynecological operation, left lung biopsy, chest drain, very rarely spinal surgery and even cardiopulmonary resuscitation. There are several surgical procedures that can lead to a splenicinjury. However, from a medico-legal point of view, it is important to assess whether the cause can be attributed
Noninvasive management for iatrogenic splenicinjury caused by chest tube insertion: a case report Splenicinjury is one of the most critical complications of chest tube insertion and often requires invasive emergency management. However, noninvasive management such as delayed removal of the malpositioned tube may be considered for a stable patient without severe adverse event.
Management of paediatric splenicinjury in the New South Wales trauma system. Since the 1980's, paediatric surgeons have increasingly managed blunt splenicinjury (BSI) in children non-operatively. However, studies in North America have shown higher operation rates in non-paediatric centres and by adult surgeons. This association has not been examined elsewhere.To investigate the management of BSI in New South Wales (NSW) children, to determine the patient and hospital factors related (...) , factors associated with operation included age (OR 1.11, 95% CI 1.01-1.18, p<0.05), massive splenic disruption (OR 3.10, 95% CI 1.61-6.19, p<0.001), hollow viscus injury (OR 11.03, 95% CI 3.46-34.28, p<0.001) and transfusion (OR 7.70, 95% CI 4.54-13.16, p<0.001). Management outside a paediatric trauma centre remained significantly associated with operation, whether it be metropolitan adult trauma centre (OR 4.22 95% CI 1.70-10.52, p<0.01), rural trauma centre (OR 3.72 95% CI 1.83-7.83, p<0.001
Non-Operative Management Is As Effective As Immediate Splenectomy For Adult Patients with High-Grade Blunt SplenicInjury. The comparative effectiveness of nonoperative management (NOM) vs immediate splenectomy (IS) for hemodynamically stable adult patients with grade IV or V blunt splenicinjury (BSI) has not been clearly established in the literature.We performed a retrospective analysis of adult patients, from the 2013 to 2014 American College of Surgeons Trauma Quality Improvement Program (...) was not different between the IS and NOM patients (11.5% vs 10.0%, p = 0.33), although IS patients had a higher incidence of infectious complications (21.4% vs 16.9%, p = 0.02). The rate of NOM failure in our sample was 20.1%. Independent predictors of failed NOM included the presence of a bleeding disorder, early blood transfusion requirement, and grade V injury. Splenic artery embolization was associated with a decreased risk of NOM failure. Patients who had failed NOM had a lower in-hospital mortality rate
Organ crushing tackle: pancreatic, bowel and splenic artery injury from blunt abdominal trauma playing rugby union 26786533 2016 12 13 2018 11 13 1757-790X 2016 2016 Jan 19 BMJ case reports BMJ Case Rep Organ crushing tackle: pancreatic, bowel and splenic artery injury from blunt abdominal trauma playing rugby union. 10.1136/bcr-2015-214124 bcr2015214124 Moore Timothy T NSW Health, Manly, New South Wales, Australia. eng Case Reports Journal Article 2016 01 19 England BMJ Case Rep 101526291 1757 (...) -790X IM Abdominal Injuries diagnostic imaging etiology pathology surgery Adult Colectomy Football injuries Humans Laparotomy methods Male Pancreas injuries surgery Pancreatectomy Shock, Hemorrhagic diagnosis etiology Splenectomy Splenic Artery injuries surgery Wounds, Nonpenetrating diagnosis etiology pathology surgery 2016 1 21 6 0 2016 1 21 6 0 2016 12 15 6 0 epublish 26786533 bcr-2015-214124 10.1136/bcr-2015-214124 PMC4735394 Acta Radiol. 2015 Apr;56(4):387-96 24760286 N Engl J Med. 1994 Oct
A systematic review of splenicinjuries during colonoscopies: Evolving trends in presentation and management. Although uncommon, the incidence of splenicinjury from colonoscopy has been increasing significantly since first being reported in 1974. Early recognition is critical because mortality may be as high as 5%.We systematically searched PubMed and EMBASE to identify English-language cases of splenicinjury from colonoscopy from inception until January 26, 2015. We used descriptive (...) -significant trend toward conservative management was noted in the past 5 years (37.7% versus 23.1%), and a non-significant drop in mortality was noted (4.9% versus 5.4%).Our data support prior literature suggesting a higher incidence of splenicinjuries during colonoscopies in females, advanced age, prior history of abdominal/pelvic surgeries and biopsies/polypectomies during the procedure.Significant mortality associated with splenicinjuries during colonoscopies warrants prompt recognition
Splenicinjury following elective colonoscopy: a rare complication Splenicinjury is an extremely rare, yet serious, complication related to colonoscopy. So far, less than 80 cases have been reported worldwide since 1970. With the increasing use of colonoscopy, endoscopists, surgeons and radiologists are more likely to encounter this unusual complication. Increased splenocolic adhesions, splenomegaly or underlying splenic disease might, inter alia, constitute a predisposing factor. However (...) , it might also occur in patients without significant adhesions or underlying splenic pathology. Patients with abdominal pain, hypotension and a fall in hematocrit without rectal bleeding after colonoscopy, should be suspected of having splenicinjury. Most patients present with symptoms within 24 hours after colonoscopy, nevertheless, delayed presentations have been described as well. We report such a case of splenicinjury secondary to colonoscopy. The patient was presented with hemorrhagic shock
Colonoscopic SplenicInjury: A Simplified Radiologic Approach Colonoscopy is a commonly performed procedure for diagnosis and treatment of large bowel diseases. Recognized complications include bleeding and perforation. Splenicinjury during colonoscopy is a rare complication. We report a case of a 73-year-old woman who presented with left-sided abdominal pain after colonoscopy with finding of splenicinjury on CT scan. She was managed conservatively. We discuss the diagnostic and therapeutic (...) approach to colonoscopic splenicinjury.
Laparascopic Splenectomy Due to SplenicInjury after Colonoscopy Colonoscopy, which is routinely performed in diagnosis and treatment of colorectal disorders, is a reliable procedure. Its most frequent complications are bleeding and perforation. Splenic rupture is a very rarely met complication of colonoscopy, and delay in its diagnosis leads to increased morbidity and mortality. We presented a 69 years old female patient, who was diagnosed by computerized abdominal tomography, performed
Comparison of MDCT protocols in trauma patients with suspected splenicinjury: superior results with protocol that includes arterial and portal venous phase imaging We aimed to determine which intravenous contrast-enhanced multidetector computed tomography (MDCT) protocol produced the most accurate results for the detection of splenic vascular injury in hemodynamically stable patients who had sustained blunt abdominal trauma.We retrospectively reviewed 88 patients from 2003 to 2011 who (...) , which includes the arterial phase, in patients with suspected splenicinjury and question the utility of obtaining a delayed sequence.
Salmonella typhi Splenic Abscess Following Blunt Abdominal Injury: A Case Report Splenic abscess as a complication of enteric fever due to Salmonella typhi is a rare entity. Here, we are presenting a case of splenic abscess caused by Salmonella typhi with a blunt injury to the abdomen as the predisposing factor. The patient underwent total splenectomy due to failure of conservative management. Splenic abscess is a potential life threatening disease if left untreated. In spite of its rarity
Variation in ICU Utilization and Mortality After Blunt SplenicInjury Although trauma patients are frequently cared for in the intensive care unit (ICU), admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission.We conducted a retrospective cohort study of patients treated for blunt splenicinjuries from 2011-2014 at 30 level I and II Pennsylvania trauma (...) centers.Of 2587 patients with blunt splenicinjuries, 63.9% (1654) were admitted to the ICU. Median injury severity score was 17 overall, 13 for non-ICU patients and 17 for ICU patients (P < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9%-87.3%. Risk-adjusted mortality rates ranged from 1.2%-9.6%. There was no correlation between observed-to-expected ratios for ICU utilization