ABSTRACT
PURPOSE: Over the past few decades, the treatment of traumatic splenic injuries has shifted to nonoperative management from surgical intervention. Although some nonoperative management failure have been reported, in most trauma centers, nonoperative management is now believed to be the treatment of choice in hemodynamically stable patients. Then, in this study, we have retrospectively evaluated our experience with traumatic splenic injury. METHODS: From January 2005 to July 2009, 150 patients with blunt splenic injuries were managed in our hospital. Patients' charts were retrospectively reviewed to analyze their treatment, the patients were grouped according to those who had been admitted before October 2006, defined as the "early group", and those who had been admitted after October 2006, defined as the "late group". After the patients had been divided into two group, physiologic parameters and differences between the treatments were compared. RESULTS: 150 patients were admitted to our hospital with blunt splenic trauma. In late group, both the surgical management rate and the nonoperative management failure rate were lower than they were in the early group. CONCLUSION: We expect angioembolization to effectively replace surgery for the treatment of selected patients with blunt splenic injury and to result in fewer complications.
Subject(s)
Humans , Retrospective Studies , Trauma CentersABSTRACT
Background: Nonoperative treatment of blunt splenic injury in children has become routine standardization in Viet Nam. Objectives:This study aims to study the efficacy of nonoperative management (NOM) for blunt splenic injury (BSI) in children. Subjects and method: The records of all the patients treated in National Hospital of Pediatrics with final diagnosis blunt splenic injury between January 2000 and December 2006 were reviewed. The clinical signs, investigations, imaging studies, methods of treatment and results were analyzed. The splenic injuries were graded according to the American Association for the Surgery of Trauma (AAST). Results:There were 15 patients from one day to 12 years of age, with average injury grade 2.2. From 13 patients who were attempted NOM, only 2 patients (blunt liver injury - BLI grade 3 and 4) were operated thereafter because of continuing bleeding or worsening clinically, the remains of 12 recovered well with average hospitalized duration wasf 6 days. The NOM for BLI was successful in 11/13 (84.6%) in our series. Conclusion:NOM was highly efficient method and should be the standard initial approach for all the children with BLI. These patients must be closely monitored for prompt surgical treatment in case of NOM failure.
Subject(s)
Infant , SpleenABSTRACT
BACKGROUND: This study was to access the hemostatic effectiveness of transcatheter arterial embolization (TAE) in a blunt splenic injury. We evaluated the efficacy of using detailed angiographic examnination and embolization for the nonsurgical management of patients with spleen injury. METHODS: Blunt splenic injuries diagnosed by Computed tomography (CT) between January 1997 and December 1997 were prospectively studied according to our management algorithm. The first group (G1) consisted of patients who were observed only, the second grourp (G2) with consisted of patients receving a TAE, and the third group (G3) consisted of those receving a laparotomy. The criteria for a TAE were: 1) Type III or IV injury and 2) extravasation of contrast material revealed by CT. RESULTS: Of the total 46 patients with blunt splenic injury, 17 underwent emergency laparotomies because of associated injuries or unstable vital signs after resuscitation. Fourteen of the 17 had splenectomies and the other three had splenorrhaphies. The remaining 29 patients were considered for nonoperative management (63%), and 13 of them were selected for a TAE. Splenic angiography showed active bleeding in 12 and minor bleeding in one. The bleeding was successfully controlled by TAE in all 13 patients. Abdominal CT and scintigraphy taken after TAE disclosed well functioning spleens. The total splenic salvage rate was 63% in our patients. CONCLUSION: We could reduce the laparotomy rate and could preserve more spleens after application of TAE. Our success rate for splenic salvage should encourage more extensive use of a TAE for splenic injury.