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Splenic Injury

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81. The incidence of delayed splenic bleeding in pediatric blunt trauma. (PubMed)

The incidence of delayed splenic bleeding in pediatric blunt trauma. One of the concerns associated with nonoperative management of splenic injury in children has been delayed splenic bleed (DSB) after a period of hemostasis. This study evaluates the incidence of DSB from a multicenter 3-year prospective study of blunt splenic injuries (BSI).A 3-year prospective study was done to evaluate nonoperative management of pediatric (≤18years) BSI presenting to one of 10 pediatric trauma centers (...) . Patients were tracked at 14 and 60days. Descriptive statistics were used to summarize patient and injury characteristics.During the study period, 508 children presented with BSI. Median age was 11.6 [IQR: 7.0, 14.8]; median splenic injury grade was 3 [IQR: 2, 4]. Nonoperative management was successful in 466 (92%) with 18 (3.5%) patients undergoing splenectomy at the index admission, all within 3h of injury. No patient developed a delayed splenic bleed. At least one follow-up visit was available

2017 Journal of Pediatric Surgery

82. Tips and tricks of splenic vessel preservation during laparoscopic distal pancreatectomy. (PubMed)

Tips and tricks of splenic vessel preservation during laparoscopic distal pancreatectomy. While a laparoscopic approach can minimize postoperative morbidity in splenic vessel preserving (SVP) distal pancreatectomy (DP), this procedure can be technically challenging. A systematic approach to SVP minimizes the chances of vascular injury and maximizes the chances of successful splenic preservation. This video demonstrates a laparoscopic DP with SVP, highlighting technical tips and tricks (...) was uneventful. Pathology confirmed the diagnosis of a pT3N0. SPPT with negative margins.Here we demonstrate a systematic approach to maximize the changes of SVP in DP. This approach, as demonstrated in the video, includes optimal patient and port positioning, dissection to optimize exposure of the distal splenic vessels, techniques to minimize vascular trauma especially splenic venous trauma, as well as supplemental measures to ensure postoperative patency of splenic vessels following completion

2017 Surgical endoscopy

83. Open splenectomy for Varicella zoster induced spontaneous splenic rupture (PubMed)

Open splenectomy for Varicella zoster induced spontaneous splenic rupture Here we present a case of atraumatic splenic rupture secondary to varicella infection requiring emergency splenectomy. The presentation was as would be expected for epstein barr virus (EBV) related splenic injury, which is well documented in the literature. Dermatological findings however suggested varicella zoster, and viral serology subsequently confirmed the diagnosis.A young Romanian male presented to the emergency (...) Zoster has only been reported a handful of times. A number of surgical options are available for splenic rupture, and guidelines exist for traumatic splenic injury. There is limited guidance on the most effective surgical management for spontaneous splenic ruptures with haemodyamic compromise.Atraumatic splenic rupture should be considered as an important differential in those presenting with abdominal pain and peritonism without a history of preceding trauma. Haematological and infectious diagnoses

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2017 International journal of surgery case reports

84. Splenic hematoma as a consequence of pneumoperitoneum (PubMed)

Splenic hematoma as a consequence of pneumoperitoneum Splenic injury is a rare but serious complication of bariatric surgical procedures. Given that the need for dissection of the gastrosplenic ligament during bariatric surgical procedures, splenic injury is not unfathomable. While most subcapsular splenic hematomas may be self-limiting, continued expansion may result in splenic rupture and should, therefore, be handled with great care. With the growing rate of bariatric surgical procedures (...) worldwide, inadvertent intra-operative splenic injury may become a more prevalent surgical complication. We report that the first documented case of subcapsular hematoma and associated gas collection following laparoscopic sleeve gastrectomy, as well as, a proposed mechanism for the radiographic findings and potential complications.

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2017 Journal of surgical case reports

85. Traumatic rupture of a giant congenital splenic cyst presenting as peritonitis (PubMed)

showed a large splenic cyst with open communication to the peritoneal cavity. A congenital primary cyst was confirmed on pathology after partial splenectomy was performed. Although the majority of splenic cysts are asymptomatic, rupture can lead to acute peritoneal signs and mimic other significant causes of abdominal pain such as viscous injury or acute appendicitis. (...) Traumatic rupture of a giant congenital splenic cyst presenting as peritonitis Splenic cysts are uncommon, with large cysts and complications being rare. We describe a 6-year-old patient who initially presented 1 day after falling onto her abdomen at the playground with worsening abdominal pain and distention. An ultrasound of the abdomen demonstrated free abdominal fluid in all four quadrants. A subsequent contrast-enhanced computed tomography scan of the abdomen and pelvis was performed which

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2017 Radiology Case Reports

86. Evidence-Based Management and Controversies in Blunt Splenic Trauma (PubMed)

Evidence-Based Management and Controversies in Blunt Splenic Trauma The study aims to describe the evidence-based management and controversies in blunt splenic trauma.A shift from operative management to non-operative management (NOM) has occurred over the past decades where NOM has now become the standard of care in haemodynamically stable patients with blunt splenic injury. Splenic artery embolisation (SAE) is generally believed to increase the success rate of NOM. Not all the available (...) evidence is that optimistic about SAE however. A morbidity specifically related to SAE of up to 47% has been reported. Although high-grade splenic injury is a prognostic factor for failure of NOM, an American research group has published a study in which NOM is performed in over half of haemodynamically stable patients with grade IV or V splenic injury without leading to an increased morbidity (in terms of complications) or mortality. Another area of current investigation in the literature is the exact

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2017 Current Trauma Reports

87. Adoptive transfer of autoimmune splenic dendritic cells to lupus-prone mice triggers a B lymphocyte humoral response (PubMed)

Adoptive transfer of autoimmune splenic dendritic cells to lupus-prone mice triggers a B lymphocyte humoral response Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by increased autoantibody production that leads to multiple tissue injuries. Dendritic cells (DCs) are important orchestrators of immune responses and key components in fine-tuning the balance between tolerance and immunity. However, their role in autoimmune disorders such as SLE remains uncertain. We (...) analyzed the contribution of DCs in triggering SLE by adoptively transferring splenic DCs from aged autoimmune [NZB×NZW]F1 (BWF1) mice to young healthy BWF1 mice. We observed that the transfer of DCs from autoimmune mice to pre-autoimmune mice induced high autoantibody titers in the serum of recipient mice. Moreover, autoimmune DCs from aged BWF1 mice were crucial for the expansion and differentiation of plasmablasts and CD5+ B cells or B1-like cells in the peripheral blood, and spleen of recipient

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2017 Immunologic research

88. Splenic trauma: WSES classification and guidelines for adult and pediatric patients (PubMed)

Splenic trauma: WSES classification and guidelines for adult and pediatric patients Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially (...) considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World

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2017 World journal of emergency surgery : WJES

89. A review of the management of blunt splenic trauma in England and Wales: have regional trauma networks influenced management strategies and outcomes? (PubMed)

A review of the management of blunt splenic trauma in England and Wales: have regional trauma networks influenced management strategies and outcomes? INTRODUCTION The spleen remains one of the most frequently injured organs following blunt abdominal trauma. In 2012, regional trauma networks were launched across England and Wales with the aim of improving outcomes following trauma. This retrospective cohort study investigated the management and outcomes of blunt splenic injuries before and after (...) the establishment of regional trauma networks. METHODS A dataset was drawn from the Trauma Audit Research Network database of all splenic injuries admitted to English and Welsh hospitals from 1 April 2010 to 31 March 2014. Demographic data, injury severity, treatment modalities and outcomes were collected. Management and outcomes were compared before and after the launch of regional trauma networks. RESULTS There were 1457 blunt splenic injuries: 575 between 2010 and 2012 and 882 in 2012-14. Following

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2017 Annals of the Royal College of Surgeons of England

90. Natural IgM and TLR Agonists Switch Murine Splenic Pan-B to “Regulatory” Cells That Suppress Ischemia-Induced Innate Inflammation via Regulating NKT-1 Cells (PubMed)

Natural IgM and TLR Agonists Switch Murine Splenic Pan-B to “Regulatory” Cells That Suppress Ischemia-Induced Innate Inflammation via Regulating NKT-1 Cells Natural IgM anti-leukocyte autoantibodies (IgM-ALAs) inhibit inflammation by several mechanisms. Here, we show that pan-B cells and bone marrow-derived dendritic cells (BMDCs) are switched to regulatory cells when pretreated ex vivo with IgM. B cells are also switched to regulatory cells when pretreated ex vivo with CpG but not with LPS (...) . Pre-emptive infusion of such ex vivo induced regulatory cells protects C57BL/6 mice from ischemia-induced acute kidney injury (AKI) via regulation of in vivo NKT-1 cells, which normally amplify the innate inflammatory response to DAMPS released after reperfusion of the ischemic kidney. Such ex vivo induced regulatory pan-B cells and BMDC express low CD1d and inhibit inflammation by regulating in vivo NKT-1 in the context of low-lipid antigen presentation and by a mechanism that requires

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2017 Frontiers in immunology

91. Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience (PubMed)

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience BACKGROUND Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. MATERIAL AND METHODS A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome (...) of different splenic injury grades in trauma patients. RESULTS A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent

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2017 Medical science monitor : international medical journal of experimental and clinical research

92. Interventional radiology versus surgical management on mortality for splenic injuries: a systematic review and meta-analysis

Interventional radiology versus surgical management on mortality for splenic injuries: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne

2018 PROSPERO

93. Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study. (PubMed)

Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study. The spleen is a crucial organ in humans. However, little is known about the association of venous thromboembolism (VTE) with splenic injury and splenectomy in trauma patients. The aim of this study was to determine the subsequent risk of VTE following splenic injury and splenectomy. A nationwide retrospective cohort study was conducted by analysing data from the National Health Insurance (...) Research Database in Taiwan. We included 6,162 splenic injury patients (3,033 splenectomised and 3,129 nonsplenectomised patients) and 24,648 comparison patients who were selected by frequency match based on sex, age, and the index year during 2000-2006. All patients were followed until the occurrence of VTE, 31 December, 2011, death, or withdrawal from the insurance program. The age of patients with splenic injury was 41.93 ± 16.44 years. The incidence rates of VTE were 11.81, 8.46, and 5.21 per

2015 Thrombosis and haemostasis

94. Increased Risk of Hemorrhagic and Ischemic Strokes in Patients With Splenic Injury and Splenectomy: A Nationwide Cohort Study. (PubMed)

Increased Risk of Hemorrhagic and Ischemic Strokes in Patients With Splenic Injury and Splenectomy: A Nationwide Cohort Study. The spleen is a crucial organ in humans. Little is known about the association between stroke and splenic injury or splenectomy. The aim of this study was to determine the risk of stroke in patients with splenic injury and splenectomy.A nationwide cohort study was conducted by analyzing the National Health Insurance Research Database in Taiwan. For comparison, control (...) patients were selected and matched with splenic injury patients in a ratio of 4:1 according to age, sex, and the year of hospitalization. We analyzed the risks of stroke using a Cox proportional-hazards regression analysis.A total of 11,273 splenic injury patients, including 5294 splenectomized and 5979 nonsplenectomized patients, and 45,092 control patients were included in this study. The incidence rates of stroke were 8.05, 6.53, and 4.25 per 1000 person-years in splenic injury patients

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2015 Medicine

95. Sphingosine 1-Phosphate Receptor 3-Deficient Dendritic Cells Modulate Splenic Responses to Ischemia-Reperfusion Injury. (PubMed)

Sphingosine 1-Phosphate Receptor 3-Deficient Dendritic Cells Modulate Splenic Responses to Ischemia-Reperfusion Injury. The plasticity of dendritic cells (DCs) permits phenotypic modulation ex vivo by gene expression or pharmacologic agents, and these modified DCs can exert therapeutic immunosuppressive effects in vivo through direct interactions with T cells, either inducing T regulatory cells (T(REG)s) or causing anergy. Sphingosine 1-phosphate (S1P) is a sphingolipid and the natural ligand (...) for five G protein-coupled receptors (S1P1, S1P2, S1P3, S1P4, and S1P5), and S1PR agonists reduce kidney ischemia-reperfusion injury (IRI) in mice. S1pr3(-/-)mice are protected from kidney IRI, because DCs do not mature. We tested the therapeutic advantage of S1pr3(-/-) bone marrow-derived dendritic cell (BMDC) transfers in kidney IRI. IRI produced a rise in plasma creatinine (PCr) levels in mice receiving no cells (NCs) and mice pretreated with wild-type (WT) BMDCs. However, S1pr3(-/-) BMDC-pretreated

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2015 Journal of the American Society of Nephrology

96. Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis. (PubMed)

Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis. Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE with historical controls. The aim of this study was to investigate whether SAE improves (...) success rate compared to observation alone in contemporaneous patients with blunt splenic injury.We included adult patients with blunt splenic injury admitted to five Level 1 Trauma Centers between January 2009 and December 2012 and selected for NOM. Successful treatment was defined as splenic salvage and no splenic re-intervention. We calculated propensity scores, expressing the probability of undergoing SAE, using multivariable logistic regression and created five strata based on the quintiles

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2015 World Journal of Surgery

97. Splenic Injury in Situs Inversus Totalis – A Surgical Challenge (PubMed)

Splenic Injury in Situs Inversus Totalis – A Surgical Challenge Situs inversus totalis is a rare congenital anomaly in which position of the heart and all abdominal viscera is reversed. Situs abnormalities usually go unnoticed but may be recognized by radiography or ultrasonography as an incidental finding or during evaluation for congenital heart diseases. We present such an extremely rare and to the best of our knowledge the third reported case of an injured spleen in the right

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2015 Journal of clinical and diagnostic research : JCDR

98. Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database. (PubMed)

Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database. Nearly half of all incidental splenectomies caused by iatrogenic splenic injury occur during colorectal surgery. This study evaluates factors associated with incidental splenic procedures during colorectal surgery and their impact on short-term outcomes using a nationwide database.Patients who underwent colorectal resections between 2005 and 2012 were identified from the American (...) College of Surgeons National Surgical Quality Improvement Program database according to Current Procedural Terminology codes. Patients were classified into two groups based on whether they underwent a concurrent incidental splenic procedure at the time of the colorectal procedure. All splenic procedures except a preoperatively intended splenectomy performed in conjunction with colon or rectal resections were considered as incidental. Perioperative and short-term (30 day) outcomes were compared between

2015 Surgical endoscopy

99. Long-term risk of acute coronary syndrome in splenectomized patients due to splenic injury. (PubMed)

Long-term risk of acute coronary syndrome in splenectomized patients due to splenic injury. We aimed to assess the magnitude and duration of risk of acute coronary syndrome (ACS) associated with splenectomy for splenic injury.We identified 5139 splenectomized patients (the splenectomy cohort) to compare with 2 other cohorts for assessing the magnitude and risk of ACS: the first cohort comprising subjects without splenic injury and without splenectomy (control cohort), and the second cohort (...) comprising nonsplenectomized patients with splenic injury (nonsplenectomy cohort; n = 6391). For each splenic injury patient (n = 11530), 4 control comparisons were frequency-matched by the year of index date, age, and sex (n = 46120).The adjusted risk of ACS was significantly higher in the splenectomy group than in the control group (2.08 vs 1.68 per 1000 person-years; adjusted hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.01-1.68). The sex-specific data showed that the adjusted HR

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2015 Medicine

100. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery? (PubMed)

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery? We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors.Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated (...) into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors.The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural

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2015 Diagnostic and Interventional Radiology

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