1. bookVolume 4 (2021): Issue 1 (June 2021)
Journal Details
License
Format
Journal
eISSN
2544-8978
First Published
30 May 2018
Publication timeframe
1 time per year
Languages
English
access type Open Access

Non-operative management of blunt splenic injuries beyond safety conditions A short narrative review

Published Online: 13 Aug 2021
Volume & Issue: Volume 4 (2021) - Issue 1 (June 2021)
Page range: 46 - 52
Accepted: 19 Jul 2021
Journal Details
License
Format
Journal
eISSN
2544-8978
First Published
30 May 2018
Publication timeframe
1 time per year
Languages
English
Abstract

Although the introduction of specific guidelines regarding the acute management of trauma patients have resolved many inconsistencies in the acute treatment pathways, grey areas are still preventing consensus and unitary standards of care. The treatment of splenic injuries has seen a notable shift from splenectomy only in the early 20th century to mainly non-operative contemporary approaches. However, there is no current agreement on the optimum timing of switching from conservative to operative decisions, raising the legitimate question of whether some patients are put at risk by waiting too much or other patients are deprived of a necessary organ by not waiting enough.

This paper focuses on the non-operative paradigms of blunt splenic injuries and their immediate and long-term clinical implications presented as a short narrative review. It presents the historical perspective on the treatment of splenic injuries, the role of surgery and selective angioembolisation and their repercussions on the immunological functions of the spleen.

Keywords

1. Styner R. The Light of the Moon - Life, Death and the Birth of Advanced Trauma Life Support. 2012. Search in Google Scholar

2. Upadhyaya P. Conservative management of splenic trauma: history and current trends. Pediatr Surg Int. 2003; 19:617-627.10.1007/s00383-003-0972-y14614630 Search in Google Scholar

3. Sherman R. Perspectives in management of trauma to the spleen: 1979 presidential address, American Association for the Surgery of Trauma. J Trauma. 1980 Jan; 20(1):1–13.10.1097/00005373-198020010-00001 Search in Google Scholar

4. King H, Shuemaker HB Jr. Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952 Aug; 136(2):239–242.10.1097/00000658-195208000-00006180225814953147 Search in Google Scholar

5. Upadhyaya P, Simpson JS. Splenic trauma in children. Surg Gynecol Obstet. 1968 Apr; 126(4):781-90. Search in Google Scholar

6. Fabian TC, Bee TK, Cagianos C et al. Current issues in trauma. Curr Probl Surg. 2015; 39(12):1160–244.10.1067/msg.2002.12849912476229 Search in Google Scholar

7. Davis JJ, Cohn I, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg. 1976; 183(6):672-8.10.1097/00000658-197606000-000091344272973754 Search in Google Scholar

8. El-Matbouly M, Jabbour G, El-Menyar A, Peralta R, Abdelrahman H, Zarour A et al. Blunt splenic trauma: assessment, management, and outcomes. Surgeon. 2016; 14:52–58.10.1016/j.surge.2015.08.00126330367 Search in Google Scholar

9. Yiannoullou P, Hall C et al. A review of the management of blunt splenic trauma in England and Wales: have regional trauma networks influenced management strategies and outcomes? Ann R Coll Surg Engl. 2017 Jan; 99(1):63-69.10.1308/rcsann.2016.0325539281327791418 Search in Google Scholar

10. Zarzaur BL, Kozar R, et al. The splenic injury outcomes trial: An American Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg. 2015; 79:335–42.10.1097/TA.000000000000078226307863 Search in Google Scholar

11. Olthof DC, van der Vlies CH et al. PYTHIA Collaboration Group. Consensus strategies for the nonoperative management of patients with blunt splenic injury: a Delphi study. J Trauma Acute Care Surg. 2013; 74:1567–74.10.1097/TA.0b013e318292162723694889 Search in Google Scholar

12. Peitzman AB, Heil B, Rivera L et al. Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma. J Trauma. 2000; 49(2):177-87.10.1097/00005373-200008000-0000210963527 Search in Google Scholar

13. Coccolini F et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017 Aug 18; 12:40. Search in Google Scholar

14. Spijkerman R, Teuben MPJ, Hoosain F et al. Non-operative management for penetrating splenic trauma: how far can we go to save splenic function? World J Emerg Surg. 2017; 12:33. Search in Google Scholar

15. Smith J, Armen S, Cook CH, Martin LC. Blunt splenic injuries: have we watched long enough? J Trauma. 2008 Mar; 64(3):656-63.10.1097/TA.0b013e3181650fb4 Search in Google Scholar

16. Liu DL, Xia S, Xu W et al. Anatomy of vasculature of 850 spleen specimens and its application in partial splenectomy. Surgery. 1996; 119(1):27-33.10.1016/S0039-6060(96)80209-1 Search in Google Scholar

17. Shanmuganathan K et al. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology. 2000; 217(1):75–82.10.1148/radiology.217.1.r00oc0875 Search in Google Scholar

18. Crichton JCI et al. The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries: a systematic review and meta-analysis. J. Trauma Acute Care Surg. 2017; 83(5):934–943.10.1097/TA.0000000000001649 Search in Google Scholar

19. Requarth JA, D’Agostino RB Jr., Miller PR. Nonoperative management of adult blunt splenic injury with and without splenic artery embolotherapy: a meta-analysis. J. Trauma. 2011; 71(4):898–903. Search in Google Scholar

20. Harbrecht BG, Ko SH, Watson GA et al. Angiography for blunt splenic trauma does not improve success rate of non-operative management. J Trauma. 2007; 63:44–49. Search in Google Scholar

21. Wu SC et al. Early selective angioembolization improves success of non-operative management of blunt splenic injury. Am Surg. 2007; 73:897–902.10.1177/000313480707300915 Search in Google Scholar

22. D’Arcy Marsh, Marilyn Day, Amit Gupta et al. Trends in Blunt Splenic Injury Management: The Rise of Splenic Artery Embolization. Journal of Surgical Research. 2021; 265:86-94.10.1016/j.jss.2021.02.038 Search in Google Scholar

23. Brigden ML. Overwhelming postsplenectomy infection still a problem. West J Med. 1992; 157(4):440-443. Search in Google Scholar

24. Mebius RE, Kraal G. Structure and function of the spleen. Nat Rev Immunol. 2005; 5:606–16.10.1038/nri1669 Search in Google Scholar

25. Schimmer SJAG, van der Steeg AFW, Zuidema WP. Splenic function after angioembolization for splenic trauma in children and adults: A systematic review. Injury. Int. J. Care Injured. 2016; 47:525–530. Search in Google Scholar

26. Mooney DP, Birkmeyer NJ, Udell JV et al. Variation in the management of paediatric splenic injuries in New Hampshire. Journal of Pediatric Surgery. 1998; 33:1076-10.10.1016/S0022-3468(98)90534-6 Search in Google Scholar

27. Filipescu R, Powers C, Yu H et al. The adherence of adult trauma centers to American Pediatric Surgical Association guidelines on management of blunt splenic injuries. Journal of Pediatric Surgery. 2020; 55(9):1748-175328.10.1016/j.jpedsurg.2020.01.00132035594 Search in Google Scholar

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