Non-surgical Management of Blunt Splenic Trauma: A Comparative Analysis of Non-operative Management and Splenic Artery Embolization—Experience from a European Trauma Center

Abstract

Our study observed a high splenic salvage rate with the use of SAE as an adjunct to NOM, and suggests that it may be further improved with appropriate patient selection and an improved embolization technique.

Update: Splenic Artery Embolization in Blunt Abdominal Trauma

“…Recent data demonstrate high splenic salvage rates with the use of SAE as an adjunct to NOE in adult patients. 17 A retrospective study of children with BSI over a 10-year period at a level I trauma center published in 2015 by Bansal et al suggests that there were no statistical differences in the need for splenectomy, transfusion, or length in stay between SAE and NOM even in the presence of contrast blush. 18…”

Splenic artery embolization for atraumatic splenic rupture

“…1,7 SAE in patients with AAST grade IV-V injuries is 90%-95% successful in salvaging the spleen and this high success rate is the basis for the above recommendation, with some controversy remaining over the use of SAE in patients with grade III injuries. [2][3][4][5][6][7][10][11][12] SAE is performed under ultrasound and fluoroscopy guidance. splenic rupture caused by traumatic injuries has been published and generally agreed upon, treatment of splenic rupture of an atraumatic nature is either extrapolated from the data on traumatic injury or directed on a case by case basis.…”

“…While non‐operative management without intervention can be utilized to treat many hemodynamically stable patients, the use of SAE is recommended for a subset of such patients—hemodynamically stable patients with AAST grade IV–V injuries (AAST grade IV = laceration involving segmental or hilar vessels with >25% devascularization of the spleen; grade V = completely shattered spleen or hilar vascular injury with full devascularization of the spleen) 1,7 . SAE in patients with AAST grade IV–V injuries is 90%–95% successful in salvaging the spleen and this high success rate is the basis for the above recommendation, with some controversy remaining over the use of SAE in patients with grade III injuries 2‐7,10‐12 …”

“…A study by Renzulli et al, 16 demonstrated five major categories of pathology that result in or contribute to atraumatic splenic rupture (neoplastic, infectious, inflammatory, drug‐treatment related, and mechanical) while 6.4% of atraumatic splenic ruptures in this study, had nodiscernable etiologic factor at all (idiopathic or normal spleen). While the accepted algorithm for treatment of splenic rupture caused by traumatic injuries has been published and generally agreed upon, treatment of splenic rupture of an atraumatic nature is either extrapolated from the data on traumatic injury or directed on a case by case basis 1-7,10-12 . Case studies on atraumatic splenic injury successfully treated with SAE are growing in number, with recent cases including etiologies such as malaria vivax infection, 17,18 Babesia Microti infection, 19 T‐cell lymphocytic leukemia, 20 chronic myeloid leukemia, 21 autoimmune lymphoproliferative disease, 22 venous malformation with consumptive coagulopathy, 23 and colonoscopy 24 …”

“…In the more recent case study of mitral valve replacement for IE by Shafi et al, 25 with hemodynamic stability and moderate to severe splenic injury. [2][3][4][5][6][7][10][11][12] While the use of SAE in atraumatic splenic rupture is supported by a growing number of case studiesincluding the rare case of post-operative splenic rupture post cardiac surgery for IE -, 25 the role of SAE in atraumatic injury has not specifically been defined. [17][18][19][20][21][22][23][24] Further research is needed to understand which conditions resulting in splenic rupture may be best suited for treatment with embolization, as well as when to intervene in these cases, what criteria to base intervention on and which embolization technique may be of most benefit.…”