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European Surgery

, Volume 39, Issue 1, pp 33–38 | Cite as

Preliminary results of a prospective study of nonoperative treatment of splenic injuries caused by blunt abdominal trauma

  • P. KornpratEmail author
  • S. Uranues
  • B. Salehi
  • G. Hoebarth
  • W. Buchinger
  • M. Kuttnig
  • M. Roblegg
  • M. Tillich
Original Scientific Paper

Summary

BACKGROUND: After it was recognized that splenectomy puts patients at lifelong risk of septic complications, splenic conservation or conservative treatment after blunt abdominal trauma received increasing attention. The aim of our prospective, multicenter study was to evaluate which patients with splenic injury most benefit from non-operative treatment. METHODS: Patients were recruited prospectively from 4 surgical centers in Austria from 2003 onward. Inclusion criteria were age of at least 16 years, stable hemodynamic parameters after blunt abdominal trauma with splenic injury, and conservative treatment. After 15 months, 25 patients with a median age of 38 years entered the study (8 females, 17 males). The patients were classified according to the severity of the splenic lesion and treated conservatively according to a standardized regime. RESULTS: Conservative management was possible in 21 patients while 4 required surgery. Failure of conservative treatment was due to incidentally high dosed heparin therapy in three patients, while one patient with grade-IVb injury receiving a normal dose of prophylactic heparin treatment required splenorraphy 36 hours after the trauma. CONCLUSIONS: Preliminary results suggest that nonoperative management is a safe and effective treatment for splenic trauma.

Keywords

Spleen Blunt trauma Splenic injury Nonoperative management 

Erste Ergebnisse einer prospektiven Studie über nichtchirurgisches Management von Milzverletzungen durch stumpfes Bauchtrauma

Zusammenfassung

GRUNDLAGEN: Die Milz spielt eine wichtige Rolle in der Immunabwehr und daher hat sich das Vorgehen bei stumpfem Bauchtrauma mit einer Milzverletzung immer mehr in Richtung Milzerhaltung entwickelt. Das Ziel unserer prospektiv angelegten Studie ist es zu evaluieren, welche Patienten von einer konservativen Therapie profitieren. METHODIK: Eingeschlossen werden Patienten mit stumpfem Bauchtrauma und einer Milzverletzung, die älter als 16 Jahre und hämodynamisch stabil sind. 18 chirurgische Abteilungen in Österreich nehmen an der Studie seit Anfang 2003 teil. Bis jetzt haben wir 25 Patienten in der Studie erfasst (17 Männer, 8 Frauen). Das mittlere Alter ist 38 Jahre. Die Verletzten werden nach dem Schweregrad der Milzläsionen eingeteilt und nach einem standardisierten Therapieregime nicht operativ behandelt. ERGEBNISSE: Eine konservative Therapie wurde in 21 (84%) Fällen erfolgreich durchgeführt, bei vier Patienten musste operativ interveniert werden. Das Therapieversagen war in drei Fällen wahrscheinlich durch die hochdosierte Heparintherapie bedingt. Bei einem Patienten mit IV.-gradiger Milzverletzung musste nach 36 Stunden eine Splenorraphie durchgeführt werden. SCHLUSSFOLGERUNGEN: Nach vorläufigen Ergebnissen scheint das konservative, nicht operative Therapie-Management eine gute und effektive Behandlungsmethode zu sein.

Schlüsselwörter

Milz Stumpfes Trauma Milzverletzung Nonoperative Behandlung 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • P. Kornprat
    • 1
    Email author
  • S. Uranues
    • 1
    • 2
  • B. Salehi
    • 1
  • G. Hoebarth
    • 2
  • W. Buchinger
    • 3
  • M. Kuttnig
    • 4
  • M. Roblegg
    • 5
  • M. Tillich
    • 6
  1. 1.Clinical Division of General Surgery, Department of SurgeryMedical University of GrazGrazAustria
  2. 2.Section of Surgical Research, Department of SurgeryMedical University of GrazGrazAustria
  3. 3.Division of Trauma SurgeryWaldviertel ClinicHornAustria
  4. 4.Division of General SurgeryRegional HospitalRottenmannAustria
  5. 5.Division of Trauma SurgeryRegional HospitalJudenburgAustria
  6. 6.Department of RadiologyMedical University of GrazGrazAustria

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