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World Journal of Surgery

, Volume 42, Issue 5, pp 1358–1363 | Cite as

Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey

  • Peter Moreno
  • Matthias Von Allmen
  • Tobias Haltmeier
  • Daniel Candinas
  • Beat Schnüriger
Original Scientific Report

Abstract

Background

Non-operative management (NOM) of blunt splenic or liver injuries (solid organ injury, SOI) has become the standard of care in hemodynamically stable patients. However, the incidence of long-term symptoms in these patients is currently not known. The aim of this study was to assess long-term symptoms in patients undergoing successful NOM (sNOM) for SOI.

Methods

Long-term posttraumatic outcomes including chronic abdominal pain, irregular bowel movements, and recurrent infections were assessed using a specifically designed questionnaire and analyzed by univariable analysis.

Results

Eighty out of 138 (58%) patients with SOI undergoing sNOM) responded to the questionnaire. Median (IQR) follow-up time was 48.8 (28) months. Twenty-seven (34%) patients complained of at least one of the following symptoms: 17 (53%) chronic abdominal pain, 13 (41%) irregular bowel movements, and 8 (25%) recurrent infections. One female patient reported secondary infertility. No significant association between the above-mentioned symptoms and the Injury Severity Score, amount of hemoperitoneum, or high-grade SOI was found. Patients with chronic pain were significantly younger than asymptomatic patients (32.1 ± 14.5 vs. 48.3 ± 19.4 years, p = 0.002). Irregular bowel movements were significantly more frequent in patients with severe pelvic fractures (15.4 vs. 0.0%, p = 0.025). A trend toward a higher frequency of recurrent infections was found in patients with splenic injuries (15.9 vs. 2.8%, p = 0.067).

Conclusion

A third of patients with blunt SOI undergoing sNOM reported long-term abdominal symptoms. Younger age was associated with chronic abdominal symptoms. More studies are warranted to investigate long-term outcomes immunologic sequelae in patients after sNOM for SOI.

Notes

Compliance with ethical standards

Conflict of interest

Peter Moreno, Matthias Von Allmen, Tobias Haltmeier, Daniel Candinas, and Beat Schnüriger have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Zago TM, Pereira BM, Calderan TR, Hirano ES, Rizoli S, Fraga GP (2012) Blunt hepatic trauma: comparison between surgical and nonoperative treatment. Revista do Colegio Brasileiro de Cirurgioes 39:307–313CrossRefPubMedGoogle Scholar
  2. 2.
    Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP (2013) Non operative management of abdominal trauma—a 10 years review. World J Emerg Surg WJES 8:14CrossRefPubMedGoogle Scholar
  3. 3.
    Schnuriger B, Martens F, Eberle BM, Renzulli P, Seiler CA (2013) Candinas D [Treatment practice in patients with isolated blunt splenic injuries. A survey of Swiss traumatologists]. Der Unfallchirurg 116:47–52CrossRefPubMedGoogle Scholar
  4. 4.
    Olthof DC, van der Vlies CH, Goslings JC (2017) Evidence-based management and controversies in blunt splenic trauma. Curr Trauma Rep 3:32–37CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Schnuriger B, Inderbitzin D, Schafer M, Kickuth R, Exadaktylos A, Candinas D (2009) Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma. Br J Surg 96:104–110CrossRefPubMedGoogle Scholar
  6. 6.
    Renzulli P, Gross T, Schnuriger B et al (2010) Management of blunt injuries to the spleen. Br J Surg 97:1696–1703CrossRefPubMedGoogle Scholar
  7. 7.
    Peitzman AB, Heil B, Rivera L et al (2000) Blunt splenic injury in adults: multi-institutional study of the eastern association for the surgery of trauma. J Trauma 49:177–187 (discussion 87–89) CrossRefPubMedGoogle Scholar
  8. 8.
    Freitas G, Olufajo OA, Hammouda K et al (2016) Postdischarge complications following nonoperative management of blunt splenic injury. Am J Surg 211(744–9):e1Google Scholar
  9. 9.
    Wernick B, Cipriano A, Odom SR et al (2017) Temporal changes in hematologic markers after splenectomy, splenic embolization, and observation for trauma. Eur J Trauma Emerg Surg 43:399–409CrossRefPubMedGoogle Scholar
  10. 10.
    Skattum J, Titze TL, Dormagen JB et al (2012) Preserved splenic function after angioembolisation of high grade injury. Injury 43:62–66CrossRefPubMedGoogle Scholar
  11. 11.
    Skattum J, Loekke RJ, Titze TL et al (2014) Preserved function after angioembolisation of splenic injury in children and adolescents: a case control study. Injury 45:156–159CrossRefPubMedGoogle Scholar
  12. 12.
    Olufajo OA, Rios-Diaz A, Peetz AB et al (2016) Comparing readmissions and infectious complications of blunt splenic injuries using a statewide database. Surg Infect 17:191–197CrossRefGoogle Scholar
  13. 13.
    Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 38:323–324CrossRefPubMedGoogle Scholar
  14. 14.
    Ahmed W, Alwe R, Wade D (2017) One-year functional outcomes following major trauma: experience of a UK level 1 major trauma centre. Clin Rehabil.  https://doi.org/10.1177/0269215517712044 PubMedGoogle Scholar
  15. 15.
    Chin WS, Shiao JS, Liao SC, Kuo CY, Chen CC, Guo YL (2017) Depressive, anxiety and post-traumatic stress disorders at six years after occupational injuries. Eur Arch Psychiatry Clin Neurosci 267:507–516CrossRefPubMedGoogle Scholar
  16. 16.
    Palm S, Ronnback L, Johansson B (2017) Long-term mental fatigue after traumatic brain injury and impact on employment status. J Rehabil Med 49:228–233CrossRefPubMedGoogle Scholar
  17. 17.
    Menzies D, Ellis H (1990) Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl 72:60–63PubMedPubMedCentralGoogle Scholar
  18. 18.
    Schnuriger B, Barmparas G, Branco BC, Lustenberger T, Inaba K, Demetriades D (2011) Prevention of postoperative peritoneal adhesions: a review of the literature. Am J Surg 201:111–121CrossRefPubMedGoogle Scholar
  19. 19.
    Weibel MA, Majno G (1973) Peritoneal adhesions and their relation to abdominal surgery. A postmortem study. Am J Surg 126:345–353CrossRefPubMedGoogle Scholar
  20. 20.
    Aiolfi A, Inaba K, Strumwasser A et al (2017) Splenic artery embolization versus splenectomy: analysis for early in-hospital infectious complications and outcomes. J Trauma Acute Care Surg 83:356–360CrossRefPubMedGoogle Scholar
  21. 21.
    Demetriades D, Scalea TM, Degiannis E et al (2012) Blunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study. J Trauma Acute Care Surg 72:229–234CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Peter Moreno
    • 1
  • Matthias Von Allmen
    • 1
  • Tobias Haltmeier
    • 1
  • Daniel Candinas
    • 1
  • Beat Schnüriger
    • 1
  1. 1.Department of Visceral Surgery and Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland

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