Current Management of Splenic Injuries: Who Needs a Splenectomy?
- 32 Downloads
Purpose of Review
This is a review of the current indications for splenectomy for trauma.
As the role of interventional radiology and the acceptance of non-operative strategies gain wider acceptance, the role of splenectomy is decreasing. There continues to be questions on how far the role of non-operative management can be pushed and at what cost. Alternatively, that risk must be weighed against the long and short term consequences of a splenectomy.
Emergent surgical exploration of the abdomen is indicated for hemodynamically unstable trauma patients and patients with peritonitis from an associated injury. All other patients can be considered for non-operative management with various adjuncts to maximize effectiveness.
KeywordsSplenectomy Splenic trauma Splenic embolization Complication of splenic surgery
Compliance with Ethical Guidelines
Conflict of interest
Nathan Teague Mowery, Charles Caleb Butts, and Erika Borgerding Call declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 7.•• Peitzman AB, 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 discussion 187-9. This is the definitive paper that described the scope and practice of NOM of splenic injuries. Still the most quoted paper on the topic. Google Scholar
- 12.• Cocanour CS, et al. Delayed complications of nonoperative management of blunt adult splenic trauma. Arch Surg. 1998;133(6):619–24 discussion 624-5. Describes the potential late complications of NOM therapy and predictors of failure. Google Scholar
- 16.•• Davis KA, et al. Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms. J Trauma. 1998;44(6):1008–13 discussion 1013-5. This paper describes predictors of non-operative failure and paves the way for the role of interventional radiology. Google Scholar
- 18.• Miller PR, et al. Prospective trial of angiography and embolization for all grade III to V blunt splenic injuries: nonoperative management success rate is significantly improved. J Am Coll Surg. 2014;218(4):644–8. Describes a algorithm that can optimize NOM with aggressive use of IR. Google Scholar