Abstract:Introduction : The nonoperative management of traumatic spleen injuries is the modality of
choice in patients with blunt abdominal trauma and hemodynamic stability. However,
there are still questions about the treatment indication in some groups of
patients, as well as its follow-up. Aim: Update knowledge about the spleen injury.
Method : Was performed review of the literature on the nonoperative management of blunt
injuries of the spleen in databases: Cochrane Library, Medline and SciELO. Were
evaluated arti… Show more
“…A successful outcome of conservative treatment depends on the patients' age, grade of splenic injury, hemoperitoneum volume, computed tomography findings, injury severity score, and hemodynamic stability. [4][5][6] Idiopathic spontaneous rupture of the spleen in pregnancy is a very rare complication. It has been proposed that the growing uterus changes the position of the spleen, making the spleen and its vascular pedicle more vulnerable, and that hypervolemia during pregnancy can lead to spontaneous splenic rupture during pregnancy.…”
Background: The management of a pregnant patient with splenic injury needs to be individualized, and conservative management can be opted for in certain cases. Case: A 23-year-old, gravida 3, para2, live 2, woman at 17 weeks +5 days pregnancy presented with pain in her abdomen after a fall while working at home. An ultrasound of her abdomen highlighted a subcapsular splenic hematoma on the costal surface with a hemoperitoneum. She was managed conservatively with strict vital monitoring and blood transfusion and was discharged after 4 days. Results: The patient was able to continue her pregnancy and, at 39 weeks of gestation, delivered a healthy baby. Conclusions: Conservative management can be offered to hemodynamically stable pregnant patients with splenic injuries.
“…A successful outcome of conservative treatment depends on the patients' age, grade of splenic injury, hemoperitoneum volume, computed tomography findings, injury severity score, and hemodynamic stability. [4][5][6] Idiopathic spontaneous rupture of the spleen in pregnancy is a very rare complication. It has been proposed that the growing uterus changes the position of the spleen, making the spleen and its vascular pedicle more vulnerable, and that hypervolemia during pregnancy can lead to spontaneous splenic rupture during pregnancy.…”
Background: The management of a pregnant patient with splenic injury needs to be individualized, and conservative management can be opted for in certain cases. Case: A 23-year-old, gravida 3, para2, live 2, woman at 17 weeks +5 days pregnancy presented with pain in her abdomen after a fall while working at home. An ultrasound of her abdomen highlighted a subcapsular splenic hematoma on the costal surface with a hemoperitoneum. She was managed conservatively with strict vital monitoring and blood transfusion and was discharged after 4 days. Results: The patient was able to continue her pregnancy and, at 39 weeks of gestation, delivered a healthy baby. Conclusions: Conservative management can be offered to hemodynamically stable pregnant patients with splenic injuries.
“…Conservative spleen operations 11-14 are becoming increasingly common in many services, both in trauma and in diseases related to the spleen. The splenic implant is reserved for cases in which it is not possible to preserve part of the eutopic spleen, due to generalized ischemia or technical difficulties 1 , 2 , 4 - 7 , 15 . Implanted splenic tissue reacquires morphofunctional integrity in up to three months, since it is implanted in tissue with venous drainage to the portal vein and in sufficient quantity 5 , 6 , 15 .…”
Section: Discussionmentioning
confidence: 99%
“…To prevent the complications of asplenia, the current trend in trauma, oncology and hematology has been treatment with preservation of the spleen 1 , 2 , 4 . If splenic surgery is required, conservative operations of part of the spleen or, where this is not possible, splenic implants.…”
Background:
The best site for splenic implant was not defined, mainly evaluating the
functionality of the implant.
Aim:
To evaluate the effects of autogenous splenic implantation on the
subcutaneous tissue in the survival of splenectomized rats.
Method:
Twenty-one randomly assigned rats were studied in three groups (n=7): group 1
- manipulation of the abdominal cavity and preservation of the spleen; group
2 - total splenectomy; group 3 - splenectomy and implant of the tissue
removed in the subcutaneous. The animals were followed for 90 days
postoperatively.
Results:
There was a higher mortality in groups 2 (p=0.0072) and 3 (p=0.0172) in
relation to group 1. There was no difference between groups 2 and 3
(p=0.9817).
Conclusion:
The splenic implant in the subcutaneous is ineffective in the survival of
rats submitted to splenectomy.
Patients selected for NOM should be monitored continuously
patients selected for NOM should be monitored continuously, some institutional protocols state that all patients with blunt hepatic and splenic injury should be admitted to the ICU [8]. In the survey by Olthof, 100% of the experts administered continuous monitoring, 63% of them in the ICU [23]; 96% agreed to keep monitoring for at least 3 days [33]. To date, clinical judgement still remains the most relevant aspect.…”
Section: Hospital Discharge and Icu Admissionmentioning
SummaryBackgroundNon-operative management (NOM) of blunt hepatic and splenic injuries has become popular in haemodynamically stable adult patients, despite uncertainty about efficacy, patient selection, and details of management. Up-to-date strategies and practical recommendations are presented.MethodsA selective literature search was conducted in PubMed and the Cochrane Library (1989–2016).ResultsNo randomized clinical trial was found. Non-randomized controlled trials and large retrospective and prospective series dominate. Few systematic reviews and meta-analyses are available. NOM of selected patients with blunt liver and spleen injuries is associated with low morbidity and mortality. Only data of limited evidence are available on intensity and duration of patient monitoring, repeat imaging, antithrombotic prophylaxis and return to normal activity. There is high-level evidence on early mobilisation and post-splenectomy vaccination.ConclusionNOM of blunt liver or spleen injuries is a worldwide trend, but the literature does not provide high-grade evidence for this strategy.
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