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Splenic trauma

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https://www.readbyqxmd.com/read/28501136/delayed-splenic-vascular-injury-after-nonoperative-management-of-blunt-splenic-trauma
#1
Alessandro Furlan, Mitchell E Tublin, Mitchell A Rees, Dederia H Nicholas, Jason L Sperry, Louis H Alarcon
BACKGROUND: Delayed splenic vascular injury (DSVI) is traditionally considered a rare, often clinically occult, harbinger of splenic rupture in patients with splenic trauma that are managed conservatively. The purpose of our study was to assess the incidence of DSVI and associated features in patients admitted with blunt splenic trauma and managed nonoperatively. MATERIALS AND METHODS: A retrospective analysis was conducted over a 4-y time. Patients admitted with blunt splenic trauma, managed no-operatively and with a follow-up contrast-enhanced computed tomography (CT) scan study during admission were included...
May 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28498097/the-asplenic-patient-post-insult-immunocompetence-infection-and-vaccination
#2
Brandon Dionne, Walter Dehority, Meghan Brett, Thomas R Howdieshell
BACKGROUND: Splenic injury can occur through multiple mechanisms and may result in various degrees of residual immunocompetence. Functionally or anatomically asplenic patients are at higher risk for infection, particularly with encapsulated bacteria. Vaccination is recommended to prevent infection with these organisms; however, the recommendations are routinely updated, and vaccine selection and timing are complex. METHODS: Review of the pertinent English-language literature, including the recommendations of the U...
May 12, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28492407/the-spleen-not-taken-differences-in-management-and-outcomes-of-blunt-splenic-injuries-in-teenagers-cared-for-by-adult-and-pediatric-trauma-teams-in-a-single-institution
#3
Sean O'Connor, Andrea N Doud, Leah M Sieren, Preston R Miller, Kristen A Zeller
BACKGROUND: Non-operative management (NOM) of blunt splenic injury, initially touted for the care of pediatric patients, has become the standard of care for stable trauma patients of all ages. In our institution, trauma patients <16 years old are managed by the pediatric surgery service and patients ≥16 years are managed by the adult trauma service. Angioembolization is routinely employed for adults with blunt splenic injury but rarely used for pediatric patients. A retrospective chart review was performed to determine if more liberal use of angioembolization increases the success rate of NOM of blunt splenic injury in adolescents...
May 11, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28464541/accuracy-of-dual-bolus-single-acquisition-computed-tomography-in-the-diagnosis-and-grading-of-adult-traumatic-splenic-parenchymal-and-vascular-injury
#4
Paul Marovic, Paul Anthony Beech, Jim Koukounaras, Helen Kavnoudias, Gerard S Goh
INTRODUCTION: Dual Bolus Single Acquisition Computed Tomography (DBSA-CT) has been advocated for use in trauma imaging through its ability to concurrently optimise abdominal arterial and visceral parenchymal enhancement while minimising scan times and radiation dose. However, concerns have been raised regarding excessive splenic parenchymal heterogeneity using this technique. The purpose of this study is to establish and compare the accuracy of DBSA-CT to traditional sequential multiphase scanning techniques in the diagnosis and grading of traumatic adult splenic injury...
May 2, 2017: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/28459796/splenic-artery-embolization-versus-splenectomy-analysis-for-early-in-hospital-infectious-complications-and-outcomes
#5
Alberto Aiolfi, Kenji Inaba, Aaron Strumwasser, Kazuhide Matsushima, Daniel Grabo, Elizabeth R Benjamin, Lydia Lam, Demetrios Demetriades
BACKGROUND: Splenic artery embolization has gained increasing acceptance as an important adjunct in the treatment of splenic injuries. Residual immunologic function of the spleen after embolization and its consequences on early infectious complications still remain intensely debated. The purpose of this study was to compare splenic artery embolization and splenectomy in terms of early in-hospital infectious complications and outcomes. METHODS: Two year retrospective Trauma Quality Improvement Program (TQIP) database prognostic study...
April 28, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28452894/severe-trauma-and-chronic-stress-activates-extramedullary-erythropoiesis
#6
Ines G Alamo, Kolenkode B Kannan, Tyler J Loftus, Harry Ramos, Philip A Efron, Alicia M Mohr
BACKGROUND: Severe traumatic injury is associated with bone marrow dysfunction that manifests as impaired erythropoiesis and prolonged hematopoietic progenitor cell (HPC) mobilization from the bone marrow. Extramedullary erythropoiesis, the development of red blood cells outside the bone marrow, has not been studied following severe injury and critical illness. This study examined the influence of lung contusion/hemorrhagic shock (LCHS) followed by chronic stress (CS) on the rodent spleen and to investigate the involvement of the splenic erythropoietin/erythropoietin receptor and BMP4 signaling...
April 27, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28404218/association-between-pediatric-blunt-splenic-injury-volume-and-the-splenectomy-rate
#7
Shin Miyata, Jayun Cho, Kazuhide Matsushima, Olga Lebedevskiy, Hanna Park, Courtney A Fortner, David W Bliss
BACKGROUND/PURPOSE: While pediatric trauma centers are shown to have lower splenectomy rate as compared to adult trauma centers, it remains unknown whether other institutional factors such as case volumes would have an impact on the splenectomy rate in pediatric blunt splenic injury (BSI). METHODS: Pediatric patients who sustained BSI were identified from the National Trauma Data Bank 2007-2014. A hierarchical logistic regression model was built to evaluate differences in risk-adjusted splenectomy rate and in-hospital mortality in between trauma centers with different pediatric BSI case volumes...
February 21, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28399879/splenosis-with-lower-gastrointestinal-bleeding-mimicking-colonical-gastrointestinal-stromal-tumour
#8
Shuo-Meng Xiao, Rui Xu, Xiao-Li Tang, Zhi Ding, Ji-Man Li, Xiang Zhou
BACKGROUND: Splenosis refers to the heterotopic transplantation of splenic tissue following splenic trauma or splenectomy. Splenosis is typically asymptomatic and is often identified incidentally. CASE PRESENTATION: We report a case of splenosis with colon and stomach invasion presenting as lower gastrointestinal bleeding and mimicking colonic gastrointestinal stromal tumour (GIST). The importance of suspicion for splenosis in patients with a history of splenic injury should be highlighted...
April 11, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28382255/angioembolization-is-necessary-with-any-volume-of-contrast-extravasation-in-blunt-trauma
#9
Ankur Bhakta, David S Magee, Matthew S Peterson, Michael Shay O'Mara
INTRODUCTION: Reduction of nonessential angiogram and embolization for patients sustaining blunt abdominal and pelvic trauma would allow improved utilization and decreased morbidity related to nontherapeutic embolization. We hypothesized that the nature of intravenous contrast extravasation (IVCE) on computed tomography (CT) would be directly related to the finding of extravasation on angiogram and need for embolization. METHODS: A 5-year retrospective evaluation of trauma patients with IVCE on CT...
January 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28365104/can-we-safely-decrease-intensive-care-unit-admissions-for-children-with-high-grade-isolated-solid-organ-injuries-using-the-shock-index-pediatric-age-adjusted-and-hematocrit-to-modify-apsa-admission-guidelines
#10
Mary Arbuthnot, Lindsey Bendure Armstrong, David P Mooney
BACKGROUND: In 2000, the American Pediatric Surgical Association (APSA) disseminated consensus practice guidelines for the management of blunt liver and splenic injury which included intensive care unit (ICU) admission for children with grade IV injuries. We sought to determine if we could better predict which children with isolated solid organ injuries (SOI) underwent an ICU-level intervention, thus necessitating ICU admission. METHODS: Children with isolated liver, spleen, or kidney injuries admitted to the ICU from November 2003 to August 2015 were identified in our trauma registry, and data were extracted from the medical record...
March 16, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28351519/contrast-enhanced-ultrasound-for-the-evaluation-of-blunt-pediatric-abdominal-trauma
#11
Lindsey B Armstrong, David P Mooney, Harriet Paltiel, Carol Barnewolt, Beatrice Dionigi, Mary Arbuthnot, Chinwendu Onwubiko, Susan A Connolly, Delma Y Jarrett, Jill M Zalieckas
INTRODUCTION: Blunt abdominal trauma is a common problem in children. Computed tomography (CT) is the gold standard for imaging in pediatric blunt abdominal trauma, however up to 50% of CTs are normal and CT carries a risk of radiation-induced cancer. Contrast enhanced ultrasound (CEUS) may allow accurate detection of abdominal organ injuries while eliminating exposure to ionizing radiation. METHODS: Children aged 7-18years with a CT-diagnosed abdominal solid organ injury underwent grayscale/power Doppler ultrasound (conventional US) and CEUS within 48h of injury...
March 20, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28350569/overall-splenectomy-rates-stable-despite-increasing-usage-of-angiography-in-the-management-of-high-grade-blunt-splenic-injury
#12
Scott C Dolejs, Stephanie A Savage, Jennifer L Hartwell, Ben L Zarzaur
OBJECTIVE: The purpose of this study was to understand the contemporary trends of splenectomy in blunt splenic injury (BSI) and to determine if angiography and embolization (ANGIO) may be impacting the splenectomy rate. BACKGROUND: The approach to BSI has shifted to increasing use of nonoperative management, with a greater reliance on ANGIO. However, the impact ANGIO has on splenic salvage remains unclear with little contemporary data. METHODS: The National Trauma Data Bank was used to identify patients 18 years and older with high-grade BSI (Abbreviated Injury Scale >II) treated at Level I or II trauma centers between 2008 and 2014...
March 27, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28341511/open-and-endovascular-abdominal-aortic-injury-repair-outcomes-in-polytrauma-patients
#13
Anand Dayama, Aksim Rivera, Odunayo Olorunfemi, Ahmed Mahmoud, Catherine A Fontecha, John McNelis
INTRODUCTION: The management of patients with abdominal aortic injury (AAI) remains challenging. Open repair of AAI is still the standard of care although it is associated with high mortality. In past few years, endovascular surgery has evolved as a less invasive alternative to open surgery in emergency settings. The objective of this study was to compare outcomes after open repair versus endovascular repair of AAI in polytrauma patients. METHODS: The National Trauma Data Bank, from 2008 to 2012, was queried to identify trauma patients undergoing open and endovascular repair of AAI using International Classification of Diseases, ninth Edition, and Clinical Modification codes...
March 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28303214/evidence-based-management-and-controversies-in-blunt-splenic-trauma
#14
REVIEW
D C Olthof, C H van der Vlies, J C Goslings
PURPOSE OF REVIEW: The study aims to describe the evidence-based management and controversies in blunt splenic trauma. RECENT FINDINGS: A shift from operative management to non-operative management (NOM) has occurred over the past decades where NOM has now become the standard of care in haemodynamically stable patients with blunt splenic injury. Splenic artery embolisation (SAE) is generally believed to increase the success rate of NOM. Not all the available evidence is that optimistic about SAE however...
2017: Current Trauma Reports
https://www.readbyqxmd.com/read/28292519/interventional-radiology-service-provision-and-practice-for-the-management-of-traumatic-splenic-injury-across-the-regional-trauma-networks-of-england
#15
Jane Hughes, Ashley Scrimshire, Laura Steinberg, Petros Yiannoullou, Katherine Newton, Claire Hall, Lyndsay Pearce, Andrew Macdonald
INTRODUCTION: The management of blunt splenic injuries (BSI) has evolved toward strategies that avoid splenectomy. There is growing adoption of interventional radiology (IR) techniques in non-operative management of BSI, with evidence suggesting a corresponding reduction in emergency laparotomy requirements and increased splenic preservation rates. Currently there are no UK national guidelines for the management of blunt splenic injury. This may lead to variations in management, despite the reorganisation of trauma services in England in 2012...
February 27, 2017: Injury
https://www.readbyqxmd.com/read/28282004/five-year-retrospective-review-of-blunt-renal-injuries-at-a-level-i-trauma-center
#16
COMPARATIVE STUDY
Jessica Burns, Megan Brown, Zakaria I Assi, Eric J Ferguson
We report the experience of a Level I trauma center in the management of blunt renal injury during a 5-year period, with special attention to those treated using angiography with embolization. The institutional trauma registry was queried for all patients with blunt renal injury between September 1, 2009 and August 30, 2014. Each injury was graded using the American Association for the Surgery of Trauma guidelines. Patients that underwent angiography with embolization were reviewed for case-specific information including imaging findings, treatment, materials used, clinical course, and mortality...
February 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28263173/modelling-the-effects-of-blood-component-storage-lesions-on-the-quality-of-haemostatic-resuscitation-in-massive-transfusion-for-trauma
#17
REVIEW
James A Mays, John R Hess
BACKGROUND: All blood components undergo loss of potency during storage. These loss-of-potency storage lesions are important in trauma resuscitation because they reduce the haemostatic capacity of mixtures of components that attempt to reconstitute whole blood. Even red cell storage-related loss of potency, which averages 17% with modern additive solutions, is important because 6 units of red cells must be given to achieve the effect of 5 fully potent units. MATERIALS AND METHODS: Loss of potency of stored units of red blood cells, plasma, platelets, and cryoprecipitate were summed for dilutional, storage-related, pathogen reduction-related, and splenic sequestration-related causes and expressed as fractional plasma coagulation factor concentrations and platelet counts...
March 2017: Blood Transfusion, Trasfusione del Sangue
https://www.readbyqxmd.com/read/28258447/time-to-ct-and-surgery-for-hpb-trauma-in-scotland-prior-to-the-introduction-of-major-trauma-centres
#18
P S McKechnie, D A Kerslake, R W Parks
AIMS: To assess the time taken to CT and emergency surgery for trauma patients with an injury to liver, spleen or pancreas prior to the introduction of major trauma centres (MTCs) in Scotland. METHODS: A search was performed of the Scottish Trauma Audit Group database for any patient with relevant injuries over a 2-year period. Primary outcome measures were time to CT and emergency surgery. Patient demographics were also recorded. RESULTS: A total of 211 patients were identified of whom 23 had more than one organ affected...
March 3, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28256499/portal-venous-thrombosis-developing-after-torsion-of-a-wandering-spleen
#19
Ö Yilmaz, R Kiziltan, N Almali, A Aras
Torsion of a wandering spleen is a rare disease. The symptoms and signs of this condition are only present when the splenic pedicle torts. The etiological factors are the congenital absence of the ligaments that hold the spleen in its normal anatomic position, or the relaxation of these ligaments resulting from conditions like trauma and abdominal surgery. We aimed to present a rare case with torsion of wandering spleen that consequently developed thrombosis of portal vein and its branches, taking into consideration the relevant literature...
March 2017: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/28248762/splenic-rupture-and-liver-laceration-in-an-adolescent-with-autism-spectrum-disorder
#20
Desiree Noel Wagner Neville, Jennifer R Marin
We report a case of a 16-year-old adolescent boy with autism who presented to the pediatric emergency department after falling from a standing position, with a relatively benign examination, who was found to have significant hemoperitoneum on the focused assessment with sonography in trauma examination.
March 2017: Pediatric Emergency Care
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