The role of angiography and embolization in blunt splenic trauma.

The spleen is one of the most vulnerable organs in the event of an abdominal trauma. Preservation of the spleen and of course its functions has been a continuing challenge familiar not only for trauma surgeons but also for all those for whom the integrity of this organ was a well-founded goal. Therefore nonoperative management (NOM) of spleen trauma injury has faced a continuous development, gradually becoming an option of healing by first intention among Trauma Centers. Through the development of modern technology it has become possible to keep observation documents on the evolution of blunt splenic injuries and, also, minimally invasive therapeutic approach has become possible. Out of these approaches angiography and consecutive embolization are gaining more and more ground considering the increasing experience and the convincing results that have been constantly reported in the last few years.

Grade IV blunt splenic injury--the role of proximal angioembolization. A case report and review of literature.

The authors present a case of grade IV traumatic spleen rupture (AAST-OIS) and an Injury Severity Score of 21 and a Revised Trauma Score RTS=7.841, which was managed without surgery, but with proximal splenic angioembolization (SAE), with a positive outcome. Indications, types and side-effects of SAE are also discussed with regard to blunt spleen trauma and the benefits of SAE as non-operative treatment approach. It is the first case of a grade IV splenic laceration non-operatively managed to be published in Romania.

Non-operative management of splenic trauma.

The risk of overwhelming postsplenectomy infection (OPSI) prompted the evolution toward preservation of the injured spleen. Nonoperative management (NOM) of blunt injury to the spleen in adults has become the standard of care in hemodynamically stable patients. This modality of treatment began in the 1970's in paediatric patients. It is highly successful with overall failures rates from 2% to 31% (average 10.8%)--with the majority of failures occurring in the first 24 hours. Current, NOM of splenic trauma includes splenic artery embolization.However, the criteria for NOM are controversial. In this study we present the current criteria, the evolution and failure rates of this type of management viewed through the general knowledge and, particularly, our experience.

Laparoscopic repair of post-traumatic diaphragmatic hernia: a case report.

In a large number of cases, post-traumatic diaphragmatic hernias (PTDH) are a consequence of occult diaphragmatic injuries associated with penetrating abdominal trauma. We present a case of a 26-year-old male patient who, 2 months prior to the current admission, sustained a non-penetrating stab wound to the left anterior chest below the nipple. Upon presentation the patient complained of epigastric pain radiated to the left shoulder, and nausea and vomiting. The chest X-ray, and abdominal and thoracic CT scan were inconclusive. The patient was sutured and discharged. The laparoscopic approach was selected as a diagnostic and minimally invasive therapeutic method. The suspected diagnosis of PTDH was confirmed. The herniated organs (transverse colon, small bowel loops, and greater omentum) were reduced, and the diaphragmatic defect was sutured by placing 3 non-resorbable 2.0 knots. The suture was reinforced with a composite mesh affixed with resorbable clips. Postoperative period was uneventful, and the patient was discharged 4 days later.