Damage control surgery for splenic trauma: "preserve an organ - preserve a life"

Abstract

The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.

Risks, Patterns, and Preventive Measures in the Analysis of Snowboarding Injuries

“…The spleen is frequently damaged among the solid organs in the abdominal cavity, and an early diagnosis can decrease the death rate. [29] "Boarder belly" or "snowboard spleen" is a spleen injury resulting from a fall while performing evolutions in the air. It usually affects male athletes using terrain parks [27,28].…”

Esplenectomia No Manejo Do Paciente Traumatizado

“…Na maioria dos pacientes, que apresentam grande parte destes sintomas clínicos, encontram-se lesões de grau IV ou V no baço, ou seja, lesões graves (Quadro 6. 1) (SERNA et al, 2021) Deve-se ressaltar, também, que antes da realização desta intervenção cirúrgica a equipe médica deve avaliar o estado clínico do paciente e os benefícios da cirurgia em comparação às maleficências. Por se tratar de um órgão do sistema imunológico, os indivíduos asplênicos apresentam baixos níveis de IgM, além de maior dificuldade na filtração mecânica do sangue, outra função deste órgão (SERNA et al, 2021).…”

“…• Esplenectomia parcial: Realizada quando o trauma no baço acomete uma pequena porção deste órgão ou na realização de biópsias. Embora ainda pouco realizada, esta cirurgia e rotineiramente estudada, devido ao caráter mais conservador que vem sendo adquirido nas esplenectomias (SERNA et al, 2021).…”

Maternal and cord blood parameters are associated with placental and newborn outcomes in indigenous mothers: A case study in the MINDI cohort

“…Maternal plasma volume was calculated as total blood volume x (1-hematocrit) 47 . A low maternal plasma volume was considered if < 5 th percentile for term-pregnancies (< 2.8 L) as defined by de Haas et al 48 .…”