Immunologic Function After Splenic Embolization, Is there a Difference?

Tominaga, Gail T.; Simon, Fred J.; Dandan, Imad S.; Schaffer, Kathryn B.; Kraus, Jess F.; Kan, Michael K.; Carlson, Stephen R.; Moreland, Stephen; Nelson, Trevor; Schultz, Peter; Eastman, A. Brent

doi:10.1097/ta.0b013e3181a5e7e2

Cited by 46 publications

(19 citation statements)

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“…99.2% of active trauma surgeons immunize their postsplenectomy patients, whereas only 15.4% of surgeons immunize those who undergo splenorrhaphy and 8.4% immunize patients who are managed nonoperatively [9]. It has been proposed that the decision to vaccinate be based on splenic function post-TSAE.…”

Section: Discussionmentioning

confidence: 99%

Cocaine-induced splenic rupture

Khan

Casaubon

Regan

et al. 2017

Journal of Surgical Case Reports

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Splenic rupture is a rare but serious complication from cocaine abuse. Given the ubiquitous prevalence of abuse and the potential for death from intraperitoneal bleeding, the prompt diagnosis and treatment of cocaine-induced disease including splenic rupture is essential. The management for splenic rupture from traumatic and atraumatic etiology has shifted from emergent laparotomy and splenectomy to non-operative approach with transcatheter splenic artery embolization. We report a 39-year-old male with a significant substance abuse history who presented with atraumatic splenic rupture. He was managed nonoperatively with adjunctive transcatheter splenic artery embolization. His post-procedure course was complicated by an intra-abdominal abscess requiring drainage via interventional radiology guided pigtail catheter placement and intravenous antibiotics. This case report is intended to raise awareness of the potentiating effects of cocaine use in this patient population and highlight questions raised during this patient's management.

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Section: Discussionmentioning

confidence: 99%

Cocaine-induced splenic rupture

Khan

Casaubon

Regan

et al. 2017

Journal of Surgical Case Reports

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“…Tominaga et al [26] compared levels of CD3, CD4, CD8 cells, and IgG, IgM, C3 and Compliment Factor B between patients who had undergone combined (proximal plus distal) SAE, controls and splenectomy patients. They found that CD8 levels were significantly higher in the splenectomy group, whilst still within the normal range, but otherwise there were no differences between the three groups.…”

Section: Discussionmentioning

confidence: 99%

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Foley

Kavnoudias

Cameron

et al. 2015

Cardiovasc Intervent Radiol

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Purpose To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Materials and Methods Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. Results Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation-a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. Conclusion IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

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“…1 Importantly, embolisation does not obliterate the spleen. A prospective study of 17 patients found that half the splenic bulk was preserved 12 and that serological measures of immune function were normal. Embolisation may preserve splenic function, avoiding the short and long term risks of splenectomy.…”

Section: Summary Pointsmentioning

confidence: 99%