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Splenic Injury

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61. Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan. (PubMed)

Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan. The aim of the present study was to assess whether angiography after contrast-enhanced CT (CECT) as per the policy of non-operative management would add to the risk of acute kidney injury in patients with blunt splenic injuries (BSIs).Cross-sectional study.Taiwan.Patients with BSI aged >16 years, admitted

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2016 BMJ open

62. Blunt Splenic Injury: Use of a Multidetector CT-based Splenic Injury Grading System and Clinical Parameters for Triage of Patients at Admission. (PubMed)

Blunt Splenic Injury: Use of a Multidetector CT-based Splenic Injury Grading System and Clinical Parameters for Triage of Patients at Admission. To assess the use of a dual-phase multidetector computed tomography (CT)-based grading system alone and in combination with assessment of clinical parameters at triage of patients with blunt splenic injury for determination of appropriate treatment (observation, splenic artery embolization [SAE], or splenic surgery).This HIPAA-compliant retrospective (...) study was approved by the institutional review board, and the requirement for informed consent was waived. Between January 2009 and July 2011, 171 hemodynamically stable patients with blunt splenic injury underwent multidetector CT at admission to the hospital. Images were reviewed by applying a multidetector CT-based grading system, and the amount of hemoperitoneum was quantified. Demographic data, vital signs, laboratory values, injury severity score, abbreviated injury severity, final treatment

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2014 Radiology

63. A Case of Splenic Laceration Presenting as a Delayed Complication of Colonoscopy. (PubMed)

laceration should be on the differential for patients that present with abdominal pain or hypotension after colonoscopy. Splenic injury carries a high mortality risk, and prompt, accurate diagnosis can be lifesaving.Copyright © 2019 Elsevier Inc. All rights reserved. (...) A Case of Splenic Laceration Presenting as a Delayed Complication of Colonoscopy. Colonoscopy is a frequently performed medical procedure; complications associated with this procedure often present to the emergency department (ED). Splenic laceration is a rare but life-threatening complication of colonoscopy. We report the unique case of a patient with a splenic laceration who presented after a recent colonoscopy and had no history of trauma.A 52-year-old man presented to our ED with abdominal

2019 Journal of Emergency Medicine

64. Robotic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. (PubMed)

, the number of harvested LNs in total and at the splenic hilum, and 5-year overall survival were analyzed, retrospectively.Among the 92 patients, robotic spleen-preserving splenic hilar lymphadenectomy was successfully performed in 91 patients except one who experienced intraoperative splenic artery injury which demanded splenectomy to be performed simultaneously. The overall mean operation time and console time were 287.2 ± 66.0 and 180.2 ± 47.2 min, respectively. Mean estimated blood loss was 141.1 (...) Robotic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. Robotic system may have potential advantages to facilitate the technically challenging splenic hilar lymphadenectomy during gastrectomy for gastric cancer. However, robotic spleen-preserving splenic hilar lymphadenectomy is performed infrequently not only because of the limited availability of the robot but also because of its technical difficulty. In this study, we describe our technique

2019 Surgical endoscopy

65. Multiple Splenic Infarcts Complicating Plasmodium vivax Malaria. (PubMed)

Multiple Splenic Infarcts Complicating Plasmodium vivax Malaria. Splenic infarct is a rare complication in Plasmodium vivax malaria. We report a case of splenic infarction with acute kidney injury in a case of P. vivax malaria in a 13-year-old male child who presented to the emergency department with severe pain in the left hypochondrium. The patient was managed with intravenous artesunate and oral primaquine. Pain in left hypochondrium in children with P. vivax malaria due to splenic

2019 Pediatric Emergency Care

66. Blunt splenic injury and severe brain injury: a decision analysis and implications for care (PubMed)

Blunt splenic injury and severe brain injury: a decision analysis and implications for care The initial nonoperative management (NOM) of blunt splenic injuries in hemodynamically stable patients is common. In soldiers who experience blunt splenic injuries with concomitant severe brain injury while on deployment, however, NOM may put the injured soldier at risk for secondary brain injury from prolonged hypotension.We conducted a decision analysis using a Markov process to evaluate 2 strategies (...) for managing hemodynamically stable patients with blunt splenic injuries and severe brain injury--immediate splenectomy and NOM--in the setting of a field hospital with surgical capability but no angiography capabilities. We considered the base case of a 40-year-old man with a life expectancy of 78 years who experienced blunt trauma resulting in a severe traumatic brain injury and an isolated splenic injury with an estimated failure rate of NOM of 19.6%. The primary outcome measured was life expectancy. We

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2015 Canadian Journal of Surgery

67. Splenic Rupture as a Complication of Colonoscopy (PubMed)

presented abdominal pain and syncope. The diagnosis of splenic rupture was made and a splenectomy was urgently performed. The patient's postoperative recovery was uneventful. Splenic rupture is a rare complication of colonoscopy which cannot be underestimated in the differential diagnosis of abdominal pain after this procedure. Splenic injuries may occur in apparently uncomplicated, easy colonoscopies performed by experienced endoscopists, with no risk factors identified, as in this case. (...) Splenic Rupture as a Complication of Colonoscopy Splenic rupture is a rare but serious complication after colonoscopy, with high global mortality (5%). Diagnosis requires a high index of suspicion because presentation can be subtle, nonspecific, and delayed from hours to days and then not easily attributed to a recent endoscopy. Urgent splenectomy is the most common treatment option. A 73-year-old woman was admitted to the emergency department 8 h following a diagnostic colonoscopy. She

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2016 GE Portuguese journal of gastroenterology

68. Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: An analysis of a National Trauma Registry database. (PubMed)

Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: An analysis of a National Trauma Registry database. Non-operative management has become the standard approach for treating stable patients sustaining blunt hepatic or splenic injuries in the absence of other indications for laparotomy. The liberal use of computed tomography (CT) has reduced the rate of unnecessary immediate laparotomies; however, due to its limited sensitivity in the diagnosis of hollow (...) viscus injuries (HVI), this may be at the expense of a rise in the incidence of missed HVI. The aim of this study was to assess the incidence of concomitant HVI in blunt trauma patients diagnosed with hepatic and/or splenic injuries, and to evaluate whether a correlation exists between this incidence and the severity of hepatic or splenic injuries.A retrospective cohort study involving blunt trauma patients with splenic and/or liver injuries, between the years 1998 and 2012 registered in the Israel

2014 Injury

69. A delayed presentation of splenic laceration and hemoperitoneum following an elective colonoscopy: A rare complication with uncertain risk factors (PubMed)

colonoscopy. The patient was treated conservatively. Traditionally perceived risk factors such as intra-abdominal adhesions, splenomegaly, anticoagulation use, biopsy, polypectomy, a technically challenging procedure, and anesthesia assistance have not been clearly shown to increase the incidence of splenic injury following a colonoscopy. Since the risk factors of splenic injury remain unclear, the clinical presentation is nonspecific, and the consequences can be serious, the endoscopist should make (...) A delayed presentation of splenic laceration and hemoperitoneum following an elective colonoscopy: A rare complication with uncertain risk factors Splenic laceration is a rare yet often underreported complication of colonoscopy that is infrequently discussed with the patient during the consent process. Most cases present within 48 h after the inciting colonoscopy; a delayed presentation is rare. We present a case of splenic laceration with hemoperitoneum that manifested 5 days after the initial

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2018 SAGE Open Medical Case Reports

70. Splenic abscess complicating endoscopic retrograde cholangiopancreatography (PubMed)

Splenic abscess complicating endoscopic retrograde cholangiopancreatography We present a case of splenic abscess as a probable complication following endoscopic retrograde cholangiopancreatography (ERCP). Based on a literature review, there have been 11 documented cases of splenic injury following ERCP; however, only one of those involved splenic abscess. Proposed mechanisms of injury and abscess are likely a combination of complicating factors, including manipulation of the endoscope

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2018 Proceedings (Baylor University. Medical Center)

71. Experimental Stroke Differentially Affects Discrete Subpopulations of Splenic Macrophages (PubMed)

Experimental Stroke Differentially Affects Discrete Subpopulations of Splenic Macrophages Changes to the immune system after stroke are complex and can result in both pro-inflammatory and immunosuppressive consequences. Following ischemic stroke, brain resident microglia are activated and circulating monocytes are recruited to the injury site. In contrast, there is a systemic deactivation of monocytes/macrophages that may contribute to immunosuppression and the high incidence of bacterial (...) infection experienced by stroke patients. The manipulation of macrophage subsets may be a useful therapeutic strategy to reduce infection and improve outcome in patients after stroke. Recent research has enhanced our understanding of the heterogeneity of macrophages even within the same tissue. The spleen is the largest natural reservoir of immune cells, many of which are mobilized to the site of injury after ischemic stroke and is notable for the diversity of its functionally distinct macrophage

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2018 Frontiers in immunology

72. Splenic responses play an important role in remote ischemic preconditioning-mediated neuroprotection against stroke (PubMed)

volume with an expansion of splenic lymphocytes 3 days after MCAO. Furthermore, the removal of the spleen 1 day or 2 weeks before RIPC and MCAO reduced the protective effect of RIPC on ischemic brain injury and reversed the effects of RIPC on circulating immune cell composition. RIPC significantly reduced brain infiltration of Tc and NKT cells. Prior splenectomy showed no effect on immune cell infiltration after RIPC and stroke.These results reveal an immunomodulatory effect of the spleen, effecting (...) Splenic responses play an important role in remote ischemic preconditioning-mediated neuroprotection against stroke Remote ischemic preconditioning (RIPC) of a limb has been reported to protect against ischemic stroke. Our previous results demonstrated that the RIPC-mediated neuroprotection is associated with alterations in circulating immune cell populations. Here, we evaluated the effect of the spleen, the largest reservoir of immune cells, on RIPC-mediated neuroprotection against

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2018 Journal of neuroinflammation

73. Splenic Trauma during Colonoscopy: The Role of Intra-Abdominal Adhesions (PubMed)

Splenic Trauma during Colonoscopy: The Role of Intra-Abdominal Adhesions Splenic rupture following colonoscopy is rare, first reported in 1974, with incidence of 1-21/100,000. It is critical to anticipate splenic trauma during colonoscopy as one of the causes of abdominal pain after colonoscopy especially when located in the left upper quadrant or left shoulder. Postoperative adhesions is a predisposing factor for splenic injury, and management is either operative or nonoperative, based (...) on hemodynamic stability and/or extravasation which can be seen on contrast-enhanced CT scan of the abdomen. We present a case of a splenic rupture after colonoscopy in a patient with splenocolic adhesions, requiring splenectomy as definite treatment.

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2018 Case reports in gastrointestinal medicine

74. The splenic response to stroke: from rodents to stroke subjects (PubMed)

secondary neural injury after stroke. Splenectomy 2 weeks prior to ischemic and hemorrhagic stroke in mice and rats shows decreased infarct volumes. Additionally, the spleen decreases in size following stroke in rodents. Pro-inflammatory mediators are also increased in the spleen and subsequently the brain after stroke. These data in preclinical models of stroke have led stroke neurologists to look at the splenic response in stroke subjects. The outcomes of these studies suggest the spleen is responding (...) The splenic response to stroke: from rodents to stroke subjects Stroke is the fifth leading cause of death and the leading cause of long-term disability in the USA, costing $40.2 billion in direct and indirect costs. Globally, stroke is the second leading cause of death and has a higher prevalence in lower- and middle-income countries compared to high-income countries. The role of the spleen in stroke has been studied in rodent models of stroke and is seen as a major contributor to increased

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2018 Journal of neuroinflammation

75. Embolization in Splenic Trauma

at Birmingham Study Details Study Description Go to Brief Summary: Randomized, prospective, feasibility study to begin evaluating the efficacy, safety, and cost of using either coils or vascular plugs (VPs) for proximal splenic artery embolization in the setting of traumatic splenic injury. Condition or disease Intervention/treatment Phase Trauma to the Spleen Device: Splenic artery embolization with vascular embolic coils Device: Splenic artery embolization with vascular embolic plugs Not Applicable (...) Detailed Description: Splenic preservation rates are improved for participants with high-grade splenic injuries (defined as Grade III-V injuries by the AAST guidelines) when non-operative management is supplemented by image-guided, trans-catheter splenic artery embolization (SAE). SAE is currently the standard of care for hemodynamically stable participants with high-grade splenic injuries. In proximal SAE (pSAE), the mid-splenic artery is embolized between the origins of the dorsal pancreatic artery

2018 Clinical Trials

76. Assessment of blunt splenic trauma: Which imaging scoring system is superior? (PubMed)

Assessment of blunt splenic trauma: Which imaging scoring system is superior? Spleen is the most common viscera that may be hurt in blunt abdominal trauma. Operative or nonoperative management of splenic injury is a dilemma. The American Association for the Surgery of Trauma (AAST) is the most common grading system which has been used for the management of blunt splenic injuries. The new recommended grading system assesses other aspects of splenic injury such as contrast extravasation (...) , pseudoaneurysm, arteriovenous fistula, and severity of hemoperitoneum, as well. The aim of this study is to compare and prioritize the cutoff of AAST grading system with the new recommended one.This is a cross-sectional study on patients with splenic injury caused by abdominal blunt trauma referred to Isfahan University of Medical Sciences affiliated Hospitals, Iran, in 2013-2016. All patients underwent abdominopelvic computed tomography scanning with intravenous (IV) contrast. All images were reported

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2018 Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences

77. Etiologies and risks of splenic decapsulation after endoscopic retrograde cholangiopancreatography: case report and literature review (PubMed)

bleeding, and perforation. A rare, but potentially life-threatening complication of ERCP is splenic injury. We report the case of a 60-year-old female with choledocholithiasis who sustained splenic decapsulation following ERCP. The exact causes of splenic injury are unknown, although several mechanisms are postulated. A literature review of splenic injuries post-ERCP shows that there are only 3 cases with post-ERCP splenic decapsulation. Our patient is the first one in whom splenic decapsulation (...) occurred without any risk factors or technical difficulties during the procedure. A high index of suspicion for splenic injury is required in any patient who has severe pain, anemia, or hemorrhagic shock after ERCP.

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2018 Endoscopy international open

78. Splenic Artery Pseudoaneurysm. (PubMed)

Splenic Artery Pseudoaneurysm. Splenic artery pseudoaneurysm is an extremely rare entity, although it is the most frequent location of visceral pseudoaneurysms. Trauma or previous pancreatitis (where the proteolytic pancreatic enzymes lead to the formation of pseudoaneurysm, as a result of enzymatic injury to the splenic artery wall) (Amico and Alves in Pancreatology 14: 144-145, 2014) is the most frequent causes. A high degree of suspicion is required for the accurate diagnosis. The authors (...) present a case of splenic artery pseudoaneurysm in a middle-aged man who came to the emergency department with several days of abdominal pain.

2017 Journal of Gastrointestinal Surgery

79. Treatment of splenic trauma in Norway: a retrospective cohort study. (PubMed)

Treatment of splenic trauma in Norway: a retrospective cohort study. Non-operative management of splenic injuries has become the treatment of choice in hemodynamically stable patients over the last decades. The aim of the study is to describe the incidence, initial treatment and early outcome of patients with splenic injuries on a national level.All hospitals in Norway admitting trauma patients were invited to participate in the study. The study period was January through December 2013 (...) . The hospitals delivered anonymous data on primarily admitted patients with splenic injury.Three of the four regional trauma centers and 26 of the remaining 33 acute care hospitals delivered data on a total of 151 patients with splenic injury indicating an incidence of 4 splenic injuries per 100,000 inhabitants/year, and a median of 4 splenic injuries per hospital per year. A total of 128 (85%) patients were successfully treated non-operatively including 20 patients who underwent an angiographic procedure

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2017 Scandinavian journal of trauma, resuscitation and emergency medicine

80. Strategy of laparoscopic surgery for colon cancer of the splenic flexure: a novel approach. (PubMed)

Strategy of laparoscopic surgery for colon cancer of the splenic flexure: a novel approach. The splenic flexure (SF) anatomy is complex due to multiple vessels, surrounding organs, layers, and irregular adhesions [1-3].Our laparoscopic approach involves a lateral-to-medial approach to the left-sided transverse mesocolon (TM), a medial-to-lateral approach to the left mesocolon (LM), and take-down of the remnant SF. First, the omental bursa is opened and its posterior wall and the anterior layer (...) , respectively. No patient needed conversion to open surgery or had organ injury, anastomotic leakage, or Clavien-Dindo III-V complications. There were 7/13/18/1 patients with Stage I/II/III/IV colon cancer, respectively. Nineteen cases had positive LNs. All patients were alive with one local and two distant recurrences at a mean 24-month follow-up.This is a safe and effective surgical strategy for treating colon cancer of the SF, strategically designed to resect the SF after dissecting the surrounding

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2017 Surgical endoscopy

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