ABSTRACT
Pneumatosis intestinalis and gastric pneumatosis are rare, but potentially morbid conditions in the burn-injured patient. They present a pediatric patient with severe scald injuries and isolated gastric pneumatosis who was successfully treated with a multidisciplinary approach and nonoperative management.
Subject(s)
Burns/complications , Burns/therapy , Critical Illness/therapy , Hyperbaric Oxygenation/methods , Pneumatosis Cystoides Intestinalis/etiology , Pneumatosis Cystoides Intestinalis/therapy , Child , Gastric Outlet Obstruction/etiology , Humans , Treatment OutcomeSubject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/microbiology , Edwardsiella tarda/isolation & purification , Enterobacteriaceae Infections/microbiology , Hepatitis C, Chronic/complications , Shock, Septic/microbiology , Animals , Antimicrobial Stewardship , Bacteremia/diagnosis , Bacteremia/drug therapy , Catfishes/microbiology , Critical Illness , Edwardsiella tarda/drug effects , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae Infections/drug therapy , Fatal Outcome , Humans , Male , Middle Aged , Severity of Illness Index , Shock, Septic/diagnosis , Shock, Septic/drug therapyABSTRACT
BACKGROUND: Contained in-bag spleen morcellation is a conventional extraction technique for safe spleen removal during laparoscopic splenectomy. Existing data for the use of in-bag enzymatic splenic digestion as an alternative to morcellation are lacking. This proof-of-concept study sought to evaluate the effectiveness of single and combinatorial enzyme digestion of murine spleens. MATERIALS AND METHODS: Murine spleens were digested with collagenase alone or with combinations of commercially available enzymes (collagenase, elastase, hyaluronidase, neutral protease) to determine their degradation effect. The primary end point was the percentage of mass reduction at 15 and 30 min. RESULTS: For collagenase alone (n = 15), the mean reduction in mass was 14 ± 10% (range: 2%-31%) at 15 min and 30 ± 25% (range: 7%-100%) at 30 min. Using combinatorial dissolution with collagenase, hyaluronidase, and elastase (n = 8), the mean reduction in mass was 27 ± 16% (range: 6%-42%) at 15 min and 48 ± 27% (range: 3%-100%) at 30 min. Injecting the enzyme solution into whole spleens (n = 9) yielded a mean reduction in mass of 22 ± 13% (range: 9%-42%) at 15 min and 55 ± 31% (range: 9%-100%) at 30 min; mean reduction was 9 ± 13% (range: 0%-39%) at 15 min and 23 ± 13% (range: 3%-53%) with no injection (n = 12). CONCLUSIONS: We provide the first demonstration of successful enzymatic murine spleen digestion as an alternative method for in-bag spleen removal during laparoscopic splenectomy. However, the significant cost and quantities of commercial enzyme required for clinical application dampens the enthusiasm for this novel approach.
