A Second Look at Delayed Splenic Rupture

Olsen, William R.; Polley, Theodore Z.

doi:10.1001/archsurg.1977.01370040074012

Cited by 70 publications

(29 citation statements)

References 6 publications

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“…Splenic injuries which is the most of solid organs are injured in blunt abdominal trauma (1). This knowledge has become a phenomenon and has entered into medical written sources (2,3).…”

Section: Dear Editormentioning

confidence: 99%

A medical approach to the treatment of atraumatic spontaneous spleen ruptures

Doğan¹,

Gündeş²,

Dönder³

et al. 2017

J Turgut Ozal Med Cent

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“…Splenic injuries which is the most of solid organs are injured in blunt abdominal trauma (1). This knowledge has become a phenomenon and has entered into medical written sources (2,3).…”

Section: Dear Editormentioning

confidence: 99%

A medical approach to the treatment of atraumatic spontaneous spleen ruptures

Doğan¹,

Gündeş²,

Dönder³

et al. 2017

J Turgut Ozal Med Cent

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“…Late bleeding is reported to occur in 0.3-1% of all splenic injuries [18]. Blunt trauma patients with concomitant injury to the liver seem to have higher injury severity scores, mortality, lengths of stay, and transfusion requirements.…”

Section: Diagnostic Proceduresmentioning

confidence: 99%

Injuries to the Spleen

Uranues

Kilic

2008

Eur J Trauma Emerg Surg

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“…During the course of a nonoperative management of splenic trauma, the sudden onset of delayed bleeding may be the result of either lysis of a subcapsular clot that had sealed parenchymal tears immediately after injury [86], or rupture of a post-traumatic false aneurysm or arteriovenous fistula. In 70% of patients the hemorrhage occurs within 2 weeks of the injury, but secondary hemorrhage in rare instances can occur months after injury [86,87,88].…”

Section: Vascular Complicationsmentioning

confidence: 99%

“…In 70% of patients the hemorrhage occurs within 2 weeks of the injury, but secondary hemorrhage in rare instances can occur months after injury [86,87,88]. As 75-90% of adults with pseudoaneurysm or arteriovenous fistula [84] and all such lesions in the pediatric population [32,89,90,91] occur only in patients having grade-III or greater injury, a follow-up CT is reasonable and mandatory only in patients with such graded injury.…”

Section: Vascular Complicationsmentioning

confidence: 99%

“…The early utilization of CT scan, before subcapsular hematoma has growth enough to be visible, may also be the reason for the delay in the detection of some discrete splenic injuries [94]. The incidence of true delayed rupture, estimated to be as high as 5-40% of all splenic injuries [95] before the CT era, seems to be less than 1% [86] if considering delayed recognition of splenic injuries. If strict criteria are used, only a few case reports can be considered as true delayed splenic rupture [92,96].…”

Section: Delayed Rupturementioning

confidence: 99%

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Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

Goffette

Laterre

2002

Eur Radiol

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The nonoperative management (NOM) of abdominal trauma has gained increasing acceptance over the past decade. This approach has been extended to severe trauma patients previously considered as candidates for surgery. Consequently, the incidence of delayed and uncommonly encountered complications has increased. Causes of delayed complications are multiple and include: (a) abnormal or insufficient injury healing process; (b) retention of necrotic tissue; (c) secondary infection of initially sterile collections; and (d) underestimation of injury severity. The purpose of this review article is to explain the role of various imaging modalities in detecting post-traumatic delayed complications and to highlight the usefulness of minimally invasive techniques, including laparoscopy, biliary endoscopy, therapeutic angiography and image-guided drainage. Subsequent complications, which do not necessarily negatively influence the final outcome, are often predictable, virtually obligatory consequences of the successful NOM of high-grade or complex abdominal injuries. Between 50 and 60% of those patients with grade-IV or grade-V liver or splenic lacerations require some type of interventional treatment; therefore, indiscriminate discharge of patients with solid organ injury managed conservatively may be potentially harmful. As the incidence of complications is higher for more severe grade-IV or grade-V liver, spleen, or kidney injuries, scheduled follow-up CT scans may be rational in this subset of patients to identify potential complications amenable to early application of interventional techniques. Follow-up CT scans are unnecessary in stable adults or children with low-grade injury. Delayed splenic or hepatic rupture is one of the major concerns because this type of complication remains difficult to predict and historically often requires emergent surgery. These ruptures may benefit from NOM, should the same criteria as for primary rupture be respected. Conversely, parenchymatous focal pooling of contrast on initial CT is a good predictor for the development of delayed vascular malformation. In children, as a large part of splenic and hepatic vascular malformations resolve spontaneously, expectant observation may be indicated provided that a strict imaging follow-up is performed until complete disappearance of these lesions. If needed, embolization of parenchymal vascular lesions should be performed as selectively as possible in order to avoid functional parenchyma loss and to reduce the risk of secondary infection of hematoma or ischemic tissue. Technical improvements, such as microcatheter systems and direct percutaneous approach to targeted lesions, have widened the potential for safe endovascular management of acquired vascular malformations. Advantages and disadvantages relative to the different embolic agents are explained. Endoscopic retrograde pancreatography is the chief investigational tool for detecting biliary and pancreatic ducts injuries. The respective roles of endoscopic, percutaneous and surgical approaches...

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A Second Look at Delayed Splenic Rupture

Cited by 70 publications

References 6 publications

A medical approach to the treatment of atraumatic spontaneous spleen ruptures

A medical approach to the treatment of atraumatic spontaneous spleen ruptures

Injuries to the Spleen

Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

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