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Splenic Injury

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161. Safe phlebotomy reduction in stable pediatric liver and spleen injuries. (PubMed)

Safe phlebotomy reduction in stable pediatric liver and spleen injuries. Pediatric blunt solid organ injury management based on hemodynamic monitoring rather than grade may safely reduce resource expenditure and improve outcomes. Previously we have reported a retrospectively validated management algorithm for pediatric liver and spleen injuries which monitors hemodynamics without use of routine phlebotomy. We hypothesize that stable blunt pediatric isolated splenic/liver injuries can be managed (...) safely using a protocol reliant on vital signs and not repeat hemoglobin levels.A prospective multi-institutional study was performed at three pediatric trauma centers. All pediatric patients from 07/2016-12/2017 diagnosed with liver or splenic injuries were identified. If appropriate for the protocol, only a baseline hemoglobin was obtained unless hemodynamic instability as defined in an age-appropriate fashion was determined by treating physician discretion. Descriptive statistics were

2019 Journal of Pediatric Surgery

162. Defining the Role of Angioembolization in Pediatric Isolated Blunt Solid Organ Injury. (PubMed)

), liver (n = 4549), and kidney (n = 2640) were identified. Use of angiography increased yearly from 1.6% to 3.1% of cases (p = 0.001) and was associated with older age (OR 2.61 [CI: 1.94-3.50], p < 0.001) and grade III or higher injury (OR 4.63 [CI: 3.11-6.90], p < 0.001). Odds of angiography were 4.9 times higher at adult trauma centers (TCs) than pediatric TCs overall, and almost 9 times higher for isolated splenic trauma (p < 0.001 for each). There was no improvement in splenic salvage after (...) angiography for high grade injuries (3.5% vs. 4.8%, p = NS). Only 1.8% of cases began within 30 min of arrival (median time = 3.6 h).Variability exists in the utilization of angiography in pediatric blunt SOI between adult and pediatric TCs, with no improvement in splenic salvage.Level III - Treatment study.Copyright © 2019 Elsevier Inc. All rights reserved.

2019 Journal of Pediatric Surgery

163. A survey of American Association for the Surgery of Trauma member practices in the management of blunt splenic injury. (PubMed)

A survey of American Association for the Surgery of Trauma member practices in the management of blunt splenic injury. Conflicting data exist regarding pseudoaneurysm screening (PSA-S), initial angioembolization (IE), deep venous thrombosis prophylaxis (DVT-P), and activity limitation after hemodynamically stable blunt splenic injury (BSI). To determine whether there was consensus regarding BSI management, the multi-institutional trial committee of the American Association for the Surgery (...) of Trauma (AAST) approved a survey of member practice patterns regarding BSI management.Over 2 months, AAST members were invited to participate in an online survey. Practice patterns and attitudes surrounding PSA-S, IE, DVT-P, and activity limitation after BSI were determined.The response rate was 37.5%. Practice patterns varied by injury grade. Observation only was thought appropriate for grades I (94.4%) and II (84.6%) injuries. For grades III to V injuries, fewer and fewer respondents felt

2011 Journal of Trauma

164. Predictive Factors of Splenic Injury in Colorectal Surgery: Data from the Nationwide Inpatient Sample, 2006-2008. (PubMed)

Predictive Factors of Splenic Injury in Colorectal Surgery: Data from the Nationwide Inpatient Sample, 2006-2008. To determine frequency of splenic injury and to evaluate predictive risk factors of splenic injury during colorectal surgery.Retrospective database analysis.The National Inpatient Sample database.Patients who underwent a colorectal resection during the period from 2006 to 2008 in the United States.Patient characteristics, patient comorbidities, type of pathology, type of resection (...) , surgical technique used, type of admission, and teaching hospital status were evaluated for splenic injury during colorectal surgery.A total of 975,825 patients underwent colorectal resection during this period. Overall, the rate of splenic injury was 0.96%, of which 84.75% were treated with complete splenectomy (splenorrhaphy, 13.55%; partial splenectomy, 1.70%). The most common procedure associated with splenic injury was transverse colectomy (3.40%). Using multivariate regression analysis, we found

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2011 Archives of Surgery

165. Risk Factors for Splenic Injury During Colectomy: A Matched Case-Control Study. (PubMed)

Risk Factors for Splenic Injury During Colectomy: A Matched Case-Control Study. We assessed risk factors for splenic injury during colectomy and associated outcomes for a 15-year period at a single institution.All adult general surgery patients who sustained a splenic injury during colectomy at our institution from 1992 to 2007 were retrospectively identified and matched 1:1 to controls without splenic injury. Putative risk factors were assessed using paired univariate analysis and conditional (...) logistic regression. Differences in short- and long-term mortality were assessed using the log-rank test. Results are reported as a proportion, median, or odds ratio [OR (95% confidence intervals)].A total of 118 patients were included: 59 patients with splenic injury and 59 control patients. Statistically significant risk factors for splenic injury during colectomy found on univariate analysis included: splenic flexure mobilization, OR 21.00 (2.82-156.12); Charlson comorbidity index≥5, OR 3.17 (1.26

2011 World Journal of Surgery

166. Management of intraoperative splenic injury during laparoscopic urological surgery. (PubMed)

Management of intraoperative splenic injury during laparoscopic urological surgery. Study Type - Therapy (case series).4. What's known on the subject? and What does the study add? The exact incidence of splenic injury during laparoscopic urologic procedures is not known; however, it is an uncommon occurrence. Also, the optimal treatment algorithm is not well delineated and the efficacy of successfully treating minor injuries to the spleen without resorting to splenectomy is not well described (...) in the urologic literature. This study outlines the rate of splenic injury during a variety of laparoscopic urologic procedures and we outline a treatment algorithm that has been successfully employed in the management of these patients, which in all cases, did not lead to splenectomy. An important point is also that multiple adjunctive hemostatic measures should be used when a splenic injury is recognized and that a thorough search should ensue when suspicion of an occult splenic injury exists

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2011 BJU international

167. Splenic injury due to colonoscopy: nursing considerations. (PubMed)

Splenic injury due to colonoscopy: nursing considerations. Complications associated with the performance of a colonoscopy are low. Splenic tearing or trauma postcolonoscopy is a rare but serious complication. Identification of a splenic injury is difficult because of the nonspecific nature of the patient's symptoms. A meta-analysis approach was used to identify common risk factors, onset and presentation of symptoms, and procedural difficulty associated with splenic injury postcolonoscopy (...) . A review of 10 published case studies and 1 case presented by the author were compared with published findings for patients sustaining a splenic injury following colonoscopy. Potential common signs and symptoms as well as common risks factors were identified. Nursing considerations for the identification of high-risk patients and postprocedure symptoms are outlined. Early detection of this rare complication is difficult, but having a high level of suspicion can help to identify patients at risk

2011 Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates

168. Blunt splenic injury in Sikkimese children and adolescents (PubMed)

Blunt splenic injury in Sikkimese children and adolescents The contemplation for the salvage operations and the nonoperative treatment for the pediatric splenic injuries had increasingly been suggested as the standard case management.The study was carried out to identify the risk factors, the presentations, the severities and outcome of the interventions of blunt splenic injuries in the children and adolescents.This retrospective review was carried out in a tertiary care hospital in Sikkim (...) on the children and adolescents admitted with splenic injury from January 2005 to December 2009. Splenic injuries were graded with the American Association for the Surgery of Trauma Splenic Injury Scale followed by the operative and nonoperative managements (NOM).Overall 147 cases with the abdominal trauma were diagnosed with splenic injury. Of them, males reported in higher numbers; three-fourths were adolescents with preponderance above 16 years of age. Majority of the cases [n=91(61.90%)] were due to fall

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2011 Journal of Emergencies, Trauma and Shock

169. Variation in the Use of Urgent Splenectomy After Blunt Splenic Injury in Adults. (PubMed)

Variation in the Use of Urgent Splenectomy After Blunt Splenic Injury in Adults. Recent reports indicate that mortality after trauma center admission may be directly related to the rate of operative intervention after blunt solid organ injury. These findings bring into question the role of urgent splenectomy after blunt splenic injury (BSI). The purpose of this study was to determine the role of urgent splenectomy (defined as splenectomy within 6 hours of admission) in the management of BSI (...) urgent splenectomy and mortality.There were 507,202 total incidents identified. Of those, 11,793 met inclusion criteria. Urgent splenectomy was performed on 1,104 (9.4%). Hierarchical models revealed that age ≥55 years, arrival systolic blood pressure ≤90 mm Hg, no or mild head injury, increasing injury severity, and massive disruption of the spleen were associated with urgent splenectomy. Hospitals level factors associated with urgent splenectomy included hospital region, hospital type, and trauma

2011 Journal of Trauma

170. Change in iron metabolism in rats after renal ischemia/reperfusion injury. (PubMed)

Change in iron metabolism in rats after renal ischemia/reperfusion injury. Previous studies have indicated that hepcidin, which can regulate iron efflux by binding to ferroportin-1 (FPN1) and inducing its internalization and degradation, acts as the critical factor in the regulation of iron metabolism. However, it is unknown whether hepcidin is involved in acute renal ischemia/reperfusion injury (IRI). In this study, an IRI rat model was established via right renal excision and blood (...) interruption for 45 min in the left kidney, and iron metabolism indexes were examined to investigate the change in iron metabolism and to analyze the role of hepcidin during IRI. From 1 to 24 h after renal reperfusion, serum creatinine and blood urea nitrogen were found to be time-dependently increased with different degrees of kidney injury. Regular variations in iron metabolism indexes in the blood and kidneys were observed in renal IRI. Renal iron content, serum iron and serum ferritin increased early

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2017 PLoS ONE

171. Is CT thorax necessary to exclude significant injury in paediatric patients with blunt chest trauma?

pneumothorax, 1 splenic laceration and 1 liver laceration found 2 pts had change in management in that moved to ITU but no pts had surgical intervention. Small study at single centre. Comment(s) It is clear that CT scans are more sensitive than plain CXRs for the detection of thoracic injuries; a more difficult question is whether this additional information is clinically important. The risks of missing a significant injury have to be balanced against the risks of the diagnostic procedure. CT scans involve (...) Is CT thorax necessary to exclude significant injury in paediatric patients with blunt chest trauma? BestBets: Is CT thorax necessary to exclude significant injury in paediatric patients with blunt chest trauma? Is CT thorax necessary to exclude significant injury in paediatric patients with blunt chest trauma? Report By: Craig Ferguson - Consultant in Emergency Medicine Search checked by Katharine de la Morandiere - Consultant in Emergency Medicine Institution: Central Manchester Foundation

2015 BestBETS

172. A solution to the negative effects of splenectomy during colorectal trauma and surgery: an experimental study on splenic autotransplantation to the groin area. (PubMed)

A solution to the negative effects of splenectomy during colorectal trauma and surgery: an experimental study on splenic autotransplantation to the groin area. Splenectomy after combined colosplenic trauma or iatrogenic splenic injury during colorectal surgery associates with worse short- and long-term outcomes, including reduced survival in patients with colorectal cancer. Splenic autotransplantation may improve the outcomes of such patients. Omental splenic transplantation is the standard (...) procedure but may be difficult when performing laparoscopic colorectal surgery or when total or subtotal omentectomy is required. This animal model study was performed to evaluate the impact of splenic autotransplantation to the groin area on colonic wound healing.Thirty rats were divided into three groups of ten animals. One group underwent colon anastomosis and sham splenectomy, the second underwent colon anastomosis and splenectomy, and the third underwent colon anastomosis, splenectomy

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2015 BMC Surgery

173. Post-traumatic liver and splenic pseudoaneurysms in children: Diagnosis, management, and follow-up screening using contrast enhanced ultrasound (CEUS). (PubMed)

Post-traumatic liver and splenic pseudoaneurysms in children: Diagnosis, management, and follow-up screening using contrast enhanced ultrasound (CEUS). Pseudoaneurysm (PA) formation following blunt and penetrating abdominal trauma is a recognized complication in solid organ injury, usually diagnosed by contrast-enhanced CT (CECT) imaging. Delayed rupture is a potentially life-threatening event, although its frequency is not known in pediatric trauma. Contrast enhanced ultrasound (CEUS (...) ) is a novel radiation-free alternative to CECT with the potential to identify PA.A retrospective review of consecutive cases of significant liver and splenic injuries admitted to single institution (tertiary and quaternary referrals) over more than a 12year period was performed. From 2011, CEUS was performed routinely postinjury (5-10days) using SonoVue™ as contrast. Initially, CECT and CEUS were performed in tandem to ensure accurate correlation.From January 2002-December 2014, 101 (73M) children [median

2015 Journal of Pediatric Surgery

174. Endovascular Treatment of Splenic Artery Aneurysm With a Stent-Graft: A Case Report. (PubMed)

Endovascular Treatment of Splenic Artery Aneurysm With a Stent-Graft: A Case Report. Splenic artery aneurysm, one of the most common visceral aneurysms, accounts for 60% of all visceral aneurysm cases. Open surgery is the traditional treatment for splenic artery aneurysm but has the disadvantages of serious surgical injuries, a high risk of complications, and a high mortality rate.We report a case who was presented with splenic artery aneurysm. A 54-year-old woman complained of upper left (...) abdominal pain for 6 months. An enhanced computed tomography scan of the upper abdomen indicated the presence of splenic artery aneurysm. The splenic artery aneurysm was located under digital subtraction angiography and a 6/60 mm stent graft was delivered and released to cover the aneurysm. An enhanced computed tomography scan showed that the splenic artery aneurysm remained well separated, the stent graft shape was normal, and the blood flow was unobstructed after 1 year.This case indicates

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2015 Medicine

175. Splenic infarction – A rare cause of acute abdominal pain following gastric surgery: A case series (PubMed)

Splenic infarction – A rare cause of acute abdominal pain following gastric surgery: A case series The dissection of splenic hilar lymph nodes in gastric cancer surgery is indispensable for treating gastric cancers located in the proximal third of the stomach. Splenic vascular injury is a matter of debate resulting on time or delayed splenectomy. We aimed to share our experience and plausible mechanisms causing this complication in two case reports.Two male patients with gastric cancer were (...) diagnosed with acute splenic infarction following gastric surgery in the early postoperative period. Both underwent emergent exploratory laparotomy. Splenectomy was performed due to splenic infarction.Because we observed this rare complication in recent patients whose surgery was performed using vessel-sealing device for splenic hilar dissection, we suggested that extensive mobilization of the surrounding tissues of splenic vascular structures hilum using the vessel sealer could be the reason.In case

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2015 International journal of surgery case reports

176. Ultrasound Modulates the Splenic Neuroimmune Axis in Attenuating AKI. (PubMed)

Ultrasound Modulates the Splenic Neuroimmune Axis in Attenuating AKI. We showed previously that prior exposure to a modified ultrasound regimen prevents kidney ischemia-reperfusion injury (IRI) likely via the splenic cholinergic anti-inflammatory pathway (CAP) and α7 nicotinic acetylcholine receptors (α7nAChR). However, it is unclear how ultrasound stimulates the splenic CAP. Further investigating the role of the spleen in ischemic injury, we found that prior splenectomy (-7d) or chemical (...) sympathectomy of the spleen with 6-hydroxydopamine (6OHDA; -14d) exacerbated injury after subthreshold (24-minute ischemia) IRI. 6-OHDA-induced splenic denervation also prevented ultrasound-induced protection of kidneys from moderate (26-minute ischemia) IRI. Ultrasound-induced protection required hematopoietic but not parenchymal α7nAChRs, as shown by experiments in bone marrow chimeras generated with wild-type and α7nAChR(-/-) mice. Ultrasound protection was associated with reduced expression

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2015 Journal of the American Society of Nephrology

177. Totally laparoscopic spleen-preserving splenic hilum lymph nodes dissection in radical total gastrectomy: an omnibearing method. (PubMed)

, and no perioperative death occurred. The mean operating time was 328.75 ± 46.96 min, and the mean estimated blood loss was 135.63 ± 62.07 ml. One patient experienced intraoperative bleeding due to the splenic vein injury which was successfully handled with laparoscopic vessel suturing, and one postoperative pulmonary infection was recorded. The mean time to first flatus was 3.56 ± 1.03 days with a mean 9.63 ± 1.50 days of postoperative hospital stay. The mean number of retrieved LNs was 28.31 ± 5.99, in which LNs (...) Totally laparoscopic spleen-preserving splenic hilum lymph nodes dissection in radical total gastrectomy: an omnibearing method. To investigate the feasibility and safety of laparoscopic spleen-preserving splenic hilum lymph nodes (LNs) dissection for advanced proximal gastric cancer using an omnibearing method.Between August 2013 and December 2014, 16 patients with advanced proximal gastric cancer treated in Guangdong Province Hospital of Chinese Medicine, were enrolled and subsequently

2015 Surgical endoscopy

178. Migration of splenic lymphocytes promotes liver fibrosis through modification of T helper cytokine balance in mice. (PubMed)

Migration of splenic lymphocytes promotes liver fibrosis through modification of T helper cytokine balance in mice. Sustained liver injury causes liver fibrosis and eventually cirrhosis. Understanding the pathophysiological mechanisms of liver fibrosis and interventions in the fibrotic process is crucial for improving the prognosis of patients with chronic liver diseases. Although studies have shown that splenectomy suppresses liver fibrosis, the mechanism by which this occurs is poorly (...) ) cytokines demonstrated that splenectomy shifted the Th1/Th2 balance in the liver towards Th1 dominance. In SCID mice, the inhibitory effect on liver fibrosis was abrogated. The number of CD4(+) T helper lymphocytes in the spleen decreased after liver injury. Green fluorescent protein positive (GFP(+)) splenocytes were transplanted into the spleens of syngeneic wild-type mice to trace their destination after fibrosis induction. GFP(+)CD4(+) lymphocytes appeared in the liver after induction of fibrosis

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2015 Journal of gastroenterology

179. Twenty-years of splenic preservation at a level 1 pediatric trauma center. (PubMed)

Twenty-years of splenic preservation at a level 1 pediatric trauma center. Splenic preservation is the standard of care for hemodynamically stable children with splenic injuries. We report a 20-year single-institutional series of children with splenic injuries managed without a splenectomy.Children evaluated and treated for blunt splenic injury at Boston Children's Hospital from 1994 to 2014 were extracted from the trauma registry. Demographics, clinical characteristics, complications (...) , and outcomes were reviewed. Three time-periods were evaluated based upon the development and modification of splenic injury clinical pathway guidelines (CPGs). Survival was defined as being discharged from the hospital alive.502 suffered isolated splenic injuries. The median AAST grade of splenic injury increased across the three CPG time periods (p<0.001). No splenic-injury related mortalities occurred. Hospital length of stay decreased significantly secondary to splenic injury CPGs (p<0.001). 99

2015 Journal of Pediatric Surgery

180. A Three-Step Method for Laparoscopic Mobilization of the Splenic Flexure. (PubMed)

A Three-Step Method for Laparoscopic Mobilization of the Splenic Flexure. Splenic flexure mobilization (SFM) is sometimes required for secure and tension-free anastomosis during laparoscopic colorectal surgery. Although several approaches have been used for laparoscopic SFM,1 it is still considered complicated and troublesome because of the lack of a standardized technique. We propose a three-step method for laparoscopic SFM, aimed at providing a simplified and standardized method, which (...) is cut using the inserted gauze as a landmark. Third, the lateral attachment of the descending colon to the left abdominal wall is dissected cranially or caudally.Using this method, we performed laparoscopic SFM for 13 patients with colorectal cancer with no conversion to another approach or to open surgery. No intraoperative complications were reported, including bleeding from the spleen and injury of the pancreas. The mean time for SFM was 55 min.We consider this three-step method as being useful

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2015 Annals of Surgical Oncology

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