Nonoperative management of splenic injury: are follow-up computed tomographic scans of any value?

OBJECTIVE: To determine the value of follow-up abdominal computed tomography in patients with splenic trauma managed nonoperatively. DESIGN: Retrospective chart review. MATERIALS AND METHODS: A total of 108 consecutive patients with splenic injuries treated at a single institution from 1990 to 1996 were studied. All admission and follow-up computed tomographic (CT) scans were reviewed by the authors. RESULTS: Initial management was surgical in 35 patients (32%) and intentionally nonoperative in 73 patients (68%). Nonoperative management was successful in 45 of 49 adults (92%) and 21 of 24 children(88%). Sixty-two follow-up abdominal CT scans were obtained in 49 patients. Information that affected management was evident on only one follow-up CT scan performed in the absence of clinical indications. Potential savings in hospital and physician charges for routine follow-up CT scans in this study were $54,302.00. CONCLUSIONS: Follow-up abdominal CT scans are not routinely necessary in patients with splenic injuries managed nonoperatively.

Neoplasms in long-term Hartmann's pouches.

A Hartmann's pouch is a blind segment of the rectum created in conjunction with a colon resection in which primary bowel reanastomosis is judged unsafe. Often forgotten, this defunctionalized rectal pouch has a high potential of pathologic lesions, including disuse proctitis, ulcers, bleeding and occasionally neoplasm formation. What are the consequences of Hartmann's pouches left unattended? In this paper, we discuss three patients with neoplasms in a long-term Hartmann's pouch and the pathophysiology of the long-term defunctionalized rectum. We also question the possibility of increased incidences of neoplasms in long-term Hartmann's pouches. To monitor this we recommend close observation of the rectal pouch with proctoscopy and contrast studies.