Improved Success in Nonoperative Management of Blunt Splenic Injuries
- 1 June 1998
- journal article
- Published by Wolters Kluwer Health
- Vol. 44 (6), 1008-1015
- https://doi.org/10.1097/00005373-199806000-00013
Abstract
By using abdominal computed tomographic scans in the evaluation of blunt splenic trauma, we previously identified the presence of vascular blush as a predictor of failure, with a failure of nonoperative management of 13% in that series. This finding led to an alteration in our management scheme, which now includes the aggressive identification and embolization of splenic artery pseudoaneurysms. The medical records of 524 consecutive patients with blunt splenic injury managed over a 4.5-year period were reviewed for the following information: age, Injury Severity Score (ISS), American Association for the Surgery of Trauma splenic injury grade (SIG), method and outcome of management. Of the patients, 66% were male with a mean age of 32 +/- 16, and mean ISS of 25 +/- 13. A total of 180 patients (34%) were managed with urgent operation on admission (81% splenectomy (SIG 4.0), 19% splenorrhaphy (SIG 2.6)). The remaining 344 patients (66%) were hemodynamically stable and underwent computed tomographic scan and planned nonoperative management. Of these patients, 322 patients (94%) were successfully managed nonoperatively (61% of total splenic injuries). In 26 patients (8%), a contrast blush identified on computed tomographic scan was confirmed as a parenchymal pseudoaneurysm on arteriography. Twenty patients (SIG, 2.8) were successfully embolized. In six patients, technical failure precluded embolization; all required splenectomy (SIG, 4.0). A total of 22 patients (6%) failed nonoperative management, including the six with unsuccessful embolization attempts. Sixteen patients (SIG, 3.0) who had no evidence of pseudoaneurysm were explored for a falling hematocrit, hemodynamic instability, or a worsening follow-up computed tomography: 13 patients had splenectomy, and three patients had splenorrhaphy. Aggressive surveillance for and embolization of posttraumatic splenic artery pseudoaneurysms improved the rate of successful nonoperative management of blunt splenic trauma to 61%, with a nonoperative failure rate of only 6%. In comparison with our previous work, this reduction in failure of nonoperative management is a significant improvement (p < 0.03).Keywords
This publication has 12 references indexed in Scilit:
- Nonoperative management of the ruptured spleen: A revalidation of criteriaSurgery, 1996
- Embolization of Splenic Artery Branch Pseudoaneurysm after Blunt Abdominal TraumaPublished by Wolters Kluwer Health ,1996
- Management of Blunt Splenic TraumaPublished by Wolters Kluwer Health ,1995
- Delayed Presentation of Splenic Artery Pseudoaneurysms following Blunt Abdominal TraumaPublished by Wolters Kluwer Health ,1995
- DELAYED RUPTURE OF THE SPLEEN CAUSED BY AN INTRASPLENIC PSEUDOANEURYSM FOLLOWING BLUNT TRAUMAPublished by Wolters Kluwer Health ,1994
- IS COMPUTED TOMOGRAPHIC GRADING OF SPLENIC INJURY USEFUL IN THE NONSURGICAL MANAGEMNT OF BLUNT TRAUMA?Published by Wolters Kluwer Health ,1994
- PROSPECTIVE VALIDATION OF CRITERIA, INCLUDING AGE, FOR SAFE, NONSURGICAL MANAGEMENT OF THE RUPTURED SPLEENPublished by Wolters Kluwer Health ,1992
- Management of Splenic InjuriesSurgical Clinics of North America, 1990
- Nonoperative Management of Adult Blunt Splenic TraumaAnnals of Surgery, 1989
- Selective Nonoperative Management of Blunt Splenic Trauma in AdultsArchives of Surgery, 1989