Skip to main content

Advertisement

SpringerLink
Log in

Management and Outcome of High-Grade Hepatic and Splenic Injuries

  • Trauma Surgery (N. Stassen, Section Editor)
  • Published:
Current Surgery Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Hepatic and splenic injuries are commonly found in patients who experience trauma and result in significant morbidity and mortality. Historically, operative intervention was the first and only approach to high grade injury. Recently non-operative and endovascular interventions are increasingly utilized. However, exact indications for these approaches have yet to be fully characterized. This paper discusses the management options and outcomes of these high-grade hepatic and splenic injuries.

Recent Findings

High-grade injuries include American Association for the Surgery of Trauma grade IV and V injuries or World Society of Emergency Surgery class III and IV. Prehospital interventions should allow for permissive hypotension. Once patients arrive at the trauma bay, they should undergo primary and secondary survey and hemodynamically unstable patients should be resuscitated with balanced blood products. Patients who remain unstable should be taken to the operating room for laparotomy. Patients who transiently respond to resuscitation or are hemodynamically stable should undergo CT scanning. Those with hepatic or splenic injury and signs of active bleeding or patients who become unstable again should proceed to angiography for embolization. Stable patients, either without active signs of bleeding or after embolization, should be closely monitored with serial exams, laboratory, and radiological studies. Operative intervention varies widely from simple packing or splenectomy to complex partial hepatectomy.

Summary

Non-surgical management is an increasingly common approach to high-grade hepatic and splenic injury. Adjuncts such as angioembolization can be used to control hemorrhage in stable and transient responders to resuscitation. Operative interventions remain the modality of choice for unstable patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Recently published papers of particular interest have been highlighted as: • Of importance

  1. Statistics NCfH: Injuries. https://www.cdc.gov/nchs/fastats/injury.htm (2022). Accessed 7 Nov 2022

  2. Costa G, Tierno SM, Tomassini F, Venturini L, Frezza B, Cancrini G, et al. The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry. Ann Ital Chir. 2010;81(2):95–102.

    PubMed  Google Scholar 

  3. Kozar RA, Moore JB, Niles SE, Holcomb JB, Moore EE, Cothren CC, et al. Complications of nonoperative management of high-grade blunt hepatic injuries. J Trauma. 2005;59(5):1066–71. https://doi.org/10.1097/01.ta.0000188937.75879.ab.

    Article  PubMed  Google Scholar 

  4. Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008;207(5):646–55. https://doi.org/10.1016/j.jamcollsurg.2008.06.342.

    Article  PubMed  Google Scholar 

  5. Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15(1):24. https://doi.org/10.1186/s13017-020-00302-7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Peitzman AB, Richardson JD. Surgical treatment of injuries to the solid abdominal organs: a 50-year perspective from the Journal of Trauma. J Trauma. 2010;69(5):1011–21. https://doi.org/10.1097/TA.0b013e3181f9c216.

    Article  PubMed  Google Scholar 

  7. Richardson JD. Changes in the management of injuries to the liver and spleen. J Am Coll Surg. 2005;200(5):648–69. https://doi.org/10.1016/j.jamcollsurg.2004.11.005.

    Article  PubMed  Google Scholar 

  8. Fischer NJ, Civil ID. Haemorrhagic death from severe liver trauma has decreased in the era of haemostatic resuscitation. ANZ J Surg. 2022;92(1–2):188–94. https://doi.org/10.1111/ans.17266.

    Article  PubMed  Google Scholar 

  9. Eastridge BJ, Salinas J, McManus JG, Blackburn L, Bugler EM, Cooke WH, et al. Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma. 2007;63(2):291–7. https://doi.org/10.1097/TA.0b013e31809ed924. (discussion 7-9).

    Article  PubMed  Google Scholar 

  10. Malkin M, Nevo A, Brundage SI, Schreiber M. Effectiveness and safety of whole blood compared to balanced blood components in resuscitation of hemorrhaging trauma patients—a systematic review. Injury. 2021;52(2):182–8. https://doi.org/10.1016/j.injury.2020.10.095.

    Article  PubMed  Google Scholar 

  11. Hanna K, Bible L, Chehab M, Asmar S, Douglas M, Ditillo M, et al. Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma. J Trauma Acute Care Surg. 2020;89(2):329–35. https://doi.org/10.1097/ta.0000000000002753.

    Article  CAS  PubMed  Google Scholar 

  12. Becker A, Lin G, McKenney MG, Marttos A, Schulman CI. Is the FAST exam reliable in severely injured patients? Injury. 2010;41(5):479–83. https://doi.org/10.1016/j.injury.2009.10.054.

    Article  PubMed  Google Scholar 

  13. Ruscelli P, Gemini A, Rimini M, Santella S, Candelari R, Rosati M, et al. The role of grade of injury in non-operative management of blunt hepatic and splenic trauma: case series from a multicenter experience. Medicine (Baltimore). 2019;98(35):e16746. https://doi.org/10.1097/md.0000000000016746.

    Article  PubMed  Google Scholar 

  14. Anderson SW, Varghese JC, Lucey BC, Burke PA, Hirsch EF, Soto JA. Blunt splenic trauma: delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients. Radiology. 2007;243(1):88–95. https://doi.org/10.1148/radiol.2431060376.

    Article  PubMed  Google Scholar 

  15. Carr JA, Roiter C, Alzuhaili A. Correlation of operative and pathological injury grade with computed tomographic grade in the failed nonoperative management of blunt splenic trauma. Eur J Trauma Emerg Surg. 2012;38(4):433–8. https://doi.org/10.1007/s00068-012-0179-9.

    Article  CAS  PubMed  Google Scholar 

  16. Poletti PA, Mirvis SE, Shanmuganathan K, Killeen KL, Coldwell D. CT criteria for management of blunt liver trauma: correlation with angiographic and surgical findings. Radiology. 2000;216(2):418–27. https://doi.org/10.1148/radiology.216.2.r00au44418.

    Article  CAS  PubMed  Google Scholar 

  17. Kumar S, Kumar A, Joshi MK, Rathi V. Comparison of diagnostic peritoneal lavage and focused assessment by sonography in trauma as an adjunct to primary survey in torso trauma: a prospective randomized clinical trial. Ulus Travma Acil Cerrahi Derg. 2014;20(2):101–6. https://doi.org/10.5505/tjtes.2014.37336.

    Article  PubMed  Google Scholar 

  18. Buci S, Torba M, Gjata A, Kajo I, Bushi G, Kagjini K. The rate of success of the conservative management of liver trauma in a developing country. World J Emerg Surg. 2017;12:24. https://doi.org/10.1186/s13017-017-0135-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. •Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, et al. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg. 2018;85(6):1119–22. https://doi.org/10.1097/ta.0000000000002058. The AAST organ grading scale update is the basis for defining management strategies and underlies the majority of management pathways.

  20. •Brigode W, Adra A, Capron G, Basu A, Messer T, Starr F, et al. The American Association for the Surgery of Trauma (AAST) Liver Injury Grade Does Not Equally Predict Interventions in Blunt and Penetrating Trauma. World J Surg. 2022;46(9):2123–31. https://doi.org/10.1007/s00268-022-06595-w. This reference demonstrates the association between AAST grade and need for management strategies and underlies the importance of mechanism and grade.

  21. Afifi I, Abayazeed S, El-Menyar A, Abdelrahman H, Peralta R, Al-Thani H. Blunt liver trauma: a descriptive analysis from a level I trauma center. BMC Surg. 2018;18(1):42. https://doi.org/10.1186/s12893-018-0369-4.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schnüriger B, Inderbitzin D, Schafer M, Kickuth R, Exadaktylos A, Candinas D. Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma. Br J Surg. 2009;96(1):104–10. https://doi.org/10.1002/bjs.6439.

    Article  PubMed  Google Scholar 

  23. Leppäniemi AK, Mentula PJ, Streng MH, Koivikko MP, Handolin LE. Severe hepatic trauma: nonoperative management, definitive repair, or damage control surgery? World J Surg. 2011;35(12):2643–9. https://doi.org/10.1007/s00268-011-1309-y.

    Article  PubMed  Google Scholar 

  24. •Cirocchi R, Trastulli S, Pressi E, Farinella E, Avenia S, Morales Uribe CH, et al. Non-operative management versus operative management in high-grade blunt hepatic injury. Cochrane Database Syst Rev. 2015(8):CD010989. https://doi.org/10.1002/14651858.CD010989.pub2. The cochrane review of non-operative management and operative management of hepatic injuries highlights the importance of grade in decision making.

  25. •Kozar RA, Moore FA, Moore EE, West M, Cocanour CS, Davis J, et al. Western Trauma Association critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma 2009;67(6):1144–8; discussion 8–9. https://doi.org/10.1097/TA.0b013e3181ba361f. The Western trauma guidelines are an important algorithm for non-operative management.

  26. •Streith L, Silverberg J, Kirkpatrick AW, Hameed SM, Bathe OF, Ball CG. Optimal treatments for hepato-pancreato-biliary trauma in severely injured patients: a narrative scoping review. Can J Surg. 2020;63(5):E431–e4. https://doi.org/10.1503/cjs.013919. This review of hepatico-pancreatico-biliary injuries is a board overview of injuries and management strategies with 8400 references demonstrates management in multi-injury patients which is very common in high grade hepatic and splenic injuries.

  27. •Tan T, Luo Y, Hu J, Li F, Fu Y. Nonoperative management with angioembolization for blunt abdominal solid organ trauma in hemodynamically unstable patients: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2022. https://doi.org/10.1007/s00068-022-02054-2. Meta analysis of efficacy and safety of angioembolization in hemodynamically unstable blunt abdominal solid organ trauma found angioembolization is safe, successful, and has a low rate of adverse events. This was particularly true for patients who were transiently responsive to resuscitation.

  28. Zago TM, Pereira BM, Calderan TR, Hirano ES, Rizoli S, Fraga GP. Blunt hepatic trauma: comparison between surgical and nonoperative treatment. Rev Col Bras Cir. 2012;39(4):307–13. https://doi.org/10.1590/s0100-69912012000400011.

    Article  PubMed  Google Scholar 

  29. •Hetherington A, Cardoso FS, Lester ELW, Karvellas CJ. Liver trauma in the intensive care unit. Curr Opin Crit Care 2022;28(2):184–9. https://doi.org/10.1097/mcc.0000000000000928. This review describes the role of a multidisciplinary team including the ICU in liver trauma. Management should include hemorrhage control, restoration of hemostasis, and management of secondary complications.

  30. Thapar PM, Ghawat RM, Dalvi AN, Rokade ML, Philip RM, Warawdekar GM, et al. Massive liver trauma-multidisciplinary approach and minimal invasive surgery can salvage patients. Indian J Surg. 2013;75(Suppl 1):449–52. https://doi.org/10.1007/s12262-012-0781-4.

    Article  PubMed  Google Scholar 

  31. •Fischer NJ. Mortality following severe liver trauma is declining at Auckland City Hospital: a 14-year experience, 2006–2020. N Z Med J. 2021;134(1540):16–24. Improved hemorrhage control has led to reduction in mortality despite stable incidence of liver trauma, highlighting importance of angioembolization and need for hemostatic control in trauma.

  32. •Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S288–93. https://doi.org/10.1097/TA.0b013e318270160d. The EAST guidelines, like the WEST guidelines, are important foundations in management of these injuries.

  33. Dabbs DN, Stein DM, Scalea TM. Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries. J Trauma. 2009;66(3):621–7. https://doi.org/10.1097/TA.0b013e31819919f2. (discussion 7-9).

    Article  PubMed  Google Scholar 

  34. Kozar RA, Moore FA, Cothren CC, Moore EE, Sena M, Bulger EM, et al. Risk factors for hepatic morbidity following nonoperative management: multicenter study. Arch Surg. 2006;141(5):451–8. https://doi.org/10.1001/archsurg.141.5.451. (discussion 8-9).

    Article  PubMed  Google Scholar 

  35. •Wagner ML, Streit S, Makley AT, Pritts TA, Goodman MD. Hepatic pseudoaneurysm incidence after liver trauma. J Surg Res. 2020;256:623–8. https://doi.org/10.1016/j.jss.2020.07.054. Retrospective review found that hepatic pseudoaneurysm incidence increases with higher grade injuries. They suggest that interval CT angiography at five to seven days may be useful in high grade injury, which is important in long-term management of these complex injury patterns.

  36. Schellenberg M, Ball CG, Owattanapanich N, Emigh B, Murphy PB, Moffat B, et al. Diagnosis and management of bile leaks after severe liver injury: A Trauma Association of Canada multicenter study. J Trauma Acute Care Surg. 2022;93(6):813–20. https://doi.org/10.1097/ta.0000000000003765.

    Article  PubMed  Google Scholar 

  37. Kozar RA, Feliciano DV, Moore EE, Moore FA, Cocanour CS, West MA, et al. Western Trauma Association/critical decisions in trauma: operative management of adult blunt hepatic trauma. J Trauma. 2011;71(1):1–5. https://doi.org/10.1097/TA.0b013e318220b192.

    Article  PubMed  Google Scholar 

  38. Ball CG, Dente CJ, Shaz B, Wyrzykowski AD, Nicholas JM, Kirkpatrick AW, et al. The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: does it increase abdominal wall closure rates? Can J Surg. 2013;56(5):E128–34. https://doi.org/10.1503/cjs.020412.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Cotton BA, Gunter OL, Isbell J, Au BK, Robertson AM, Morris JA Jr, et al. Damage control hematology: the impact of a trauma exsanguination protocol on survival and blood product utilization. J Trauma. 2008;64(5):1177–82. https://doi.org/10.1097/TA.0b013e31816c5c80. (discussion 82-3).

    Article  PubMed  Google Scholar 

  40. Asensio JA, Roldán G, Petrone P, Rojo E, Tillou A, Kuncir E, et al. Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps. J Trauma. 2003;54(4):647–53. https://doi.org/10.1097/01.Ta.0000054647.59217.Bb. (discussion 53-4).

    Article  PubMed  Google Scholar 

  41. •Hashavia E, Goldstein AL, Nachmany I, Shimonov A, Klausner JM, Soffer D. Definitive repair of injuries to the liver during initial trauma laparotomy. Am Surg. 2021;87(8):1299–304. https://doi.org/10.1177/0003134820979598. This is a case series that found that, in collaboration with experienced hepatobiliary surgeons, definitive hepatic repair or resection after high grade liver injury during initial operation is safe and may be beneficial to patient outcomes.

  42. Polanco P, Leon S, Pineda J, Puyana JC, Ochoa JB, Alarcon L, et al. Hepatic resection in the management of complex injury to the liver. J Trauma. 2008;65(6):1264–9. https://doi.org/10.1097/TA.0b013e3181904749. (discussion 9-70).

    Article  PubMed  Google Scholar 

  43. •Buckman RF, Jr., Miraliakbari R, Badellino MM. Juxtahepatic venous injuries: a critical review of reported management strategies. J Trauma 2000;48(5):978–84. https://doi.org/10.1097/00005373-200005000-00030. Review of operative strategies for addressing juxtahepatic venous injuries. High grade hepatic injuries are frequently associated with concomitant venous injuries which severely increase the morbidity and mortality of these high grade injuries. Knowledge of these injury patterns and their management is key in successful treatment of high grade hepatic injuries.

  44. Badger SA, Barclay R, Campbell P, Mole DJ, Diamond T. Management of liver trauma. World J Surg. 2009;33(12):2522–37. https://doi.org/10.1007/s00268-009-0215-z.

    Article  CAS  PubMed  Google Scholar 

  45. Gurusamy KS, Samraj K, Davidson BR. Routine abdominal drainage for uncomplicated liver resection. Cochrane Database Syst Rev. 2007;3:CD006232. https://doi.org/10.1002/14651858.CD006232.pub2.

    Article  Google Scholar 

  46. •Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017;12:40. https://doi.org/10.1186/s13017-017-0151-4. Presents the World Society of Emergency Surgery (WSES) classification and management guidelines for splenic trauma. The WSES guidelines and grading systems provide important management algorithms.

  47. Swaid F, Peleg K, Alfici R, Matter I, Olsha O, Ashkenazi I, et al. Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: an analysis of a National Trauma Registry database. Injury. 2014;45(9):1409–12. https://doi.org/10.1016/j.injury.2014.02.027.

    Article  PubMed  Google Scholar 

  48. Cocanour CS, Moore FA, Ware DN, Marvin RG, Duke JH. Age should not be a consideration for nonoperative management of blunt splenic injury. J Trauma. 2000;48(4):606–10. https://doi.org/10.1097/00005373-200004000-00005. (discussion 10-2).

    Article  CAS  PubMed  Google Scholar 

  49. Athiel Y, Vivanti A, Tranchart H. Splenic embolization for abdominal trauma during pregnancy. J Visc Surg. 2020;157(1):71–2. https://doi.org/10.1016/j.jviscsurg.2019.08.004.

    Article  CAS  PubMed  Google Scholar 

  50. 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. https://doi.org/10.1097/TA.0b013e318227ea50. (discussion).

    Article  PubMed  Google Scholar 

  51. Watson GA, Hoffman MK, Peitzman AB. Nonoperative management of blunt splenic injury: what is new? Eur J Trauma Emerg Surg. 2015;41(3):219–28. https://doi.org/10.1007/s00068-015-0520-1.

    Article  CAS  PubMed  Google Scholar 

  52. Gamblin TC, Wall CE Jr, Royer GM, Dalton ML, Ashley DW. Delayed splenic rupture: case reports and review of the literature. J Trauma. 2005;59(5):1231–4. https://doi.org/10.1097/01.ta.0000197270.25280.7c.

    Article  PubMed  Google Scholar 

  53. •Arvieux C, Frandon J, Tidadini F, Monnin-Bares V, Foote A, Dubuisson V, et al. Effect of prophylactic embolization on patients with blunt trauma at high risk of splenectomy: a randomized clinical trial. JAMA Surg. 2020;155(12):1102–11. doi: https://doi.org/10.1001/jamasurg.2020.3672. This is an RCT that showed that for high grade splenic injury with high risk of rupture, patients who underwent prophylactic splenic arterial embolization vs surveillance had similar rate of splenic salvage. This suggests that both are reasonable approaches.

  54. •Rowell SE, Biffl WL, Brasel K, Moore EE, Albrecht RA, DeMoya M, et al. Western trauma association critical decisions in trauma: management of adult blunt splenic trauma-2016 updates. J Trauma Acute Care Surg. 2017;82(4):787–93. https://doi.org/10.1097/TA.0000000000001323. Western Trauma Association guidelines for operative management of blunt splenic trauma.

  55. Olthof DC, Joosse P, van der Vlies CH, de Haan RJ, Goslings JC. Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. J Trauma Acute Care Surg. 2013;74(2):546–57. https://doi.org/10.1097/TA.0b013e31827d5e3a.

    Article  PubMed  Google Scholar 

  56. Ekeh AP, Khalaf S, Ilyas S, Kauffman S, Walusimbi M, McCarthy MC. Complications arising from splenic artery embolization: a review of an 11-year experience. Am J Surg. 2013;205(3):250–4. https://doi.org/10.1016/j.amjsurg.2013.01.003. (discussion 4).

    Article  PubMed  Google Scholar 

  57. Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF. Liver cirrhosis: an unfavorable factor for nonoperative management of blunt splenic injury. J Trauma. 2003;54(6):1131–6. https://doi.org/10.1097/01.Ta.0000066123.32997.Bb. (discussion 6).

    Article  PubMed  Google Scholar 

  58. Bhangu A, Nepogodiev D, Lal N, Bowley DM. Meta-analysis of predictive factors and outcomes for failure of non-operative management of blunt splenic trauma. Injury. 2012;43(9):1337–46. https://doi.org/10.1016/j.injury.2011.09.010.

    Article  PubMed  Google Scholar 

  59. Joseph B, Pandit V, Harrison C, Lubin D, Kulvatunyou N, Zangbar B, et al. Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: is it safe? Am J Surg. 2015;209(1):194–8. https://doi.org/10.1016/j.amjsurg.2014.03.007.

    Article  PubMed  Google Scholar 

  60. Amirkazem VS, Malihe K. Randomized clinical trial of ligasure™ versus conventional splenectomy for injured spleen in blunt abdominal trauma. Int J Surg. 2017;38:48–51. https://doi.org/10.1016/j.ijsu.2016.12.036.

    Article  PubMed  Google Scholar 

  61. Nasr WI, Collins CL, Kelly JJ. Feasibility of laparoscopic splenectomy in stable blunt trauma: a case series. J Trauma. 2004;57(4):887–9. https://doi.org/10.1097/01.ta.0000057962.07187.56.

    Article  PubMed  Google Scholar 

  62. Pisters PW, Pachter HL. Autologous splenic transplantation for splenic trauma. Ann Surg. 1994;219(3):225–35. https://doi.org/10.1097/00000658-199403000-00002.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Qu Y, Ren S, Li C, Qian S, Liu P. Management of postoperative complications following splenectomy. Int Surg. 2013;98(1):55–60. https://doi.org/10.9738/CC63.1.

    Article  PubMed  PubMed Central  Google Scholar 

  64. 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(1):52–8. https://doi.org/10.1016/j.surge.2015.08.001.

    Article  PubMed  Google Scholar 

  65. Carlin AM, Tyburski JG, Wilson RF, Steffes C. Factors affecting the outcome of patients with splenic trauma. Am Surg. 2002;68(3):232–9.

    Article  PubMed  Google Scholar 

  66. Alabbasi T, Nathens AB, Tien H. Blunt splenic injury and severe brain injury: a decision analysis and implications for care. Can J Surg. 2015;58(3 Suppl 3):S108–17. https://doi.org/10.1503/cjs.015814.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Lee HR, You NK, Seo SJ, Choi MS. Concurrent surgery of craniectomy and splenectomy as initial treatment in severe traumatic head injury: a case report. Korean J Neurotrauma. 2017;13(2):141–3. https://doi.org/10.13004/kjnt.2017.13.2.141.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Sarangi J, Coleby M, Trivella M, Reilly S. Prevention of post splenectomy sepsis: a population based approach. J Public Health Med. 1997;19(2):208–12. https://doi.org/10.1093/oxfordjournals.pubmed.a024611.

    Article  CAS  PubMed  Google Scholar 

  69. Lenzing E, Rezahosseini O, Burgdorf SK, Nielsen SD, Harboe ZB. Efficacy, immunogenicity, and evidence for best-timing of pneumococcal vaccination in splenectomized adults: a systematic review. Expert Rev Vaccines. 2022;21(5):723–33. https://doi.org/10.1080/14760584.2022.2049250.

    Article  CAS  PubMed  Google Scholar 

  70. •Freeman JJ, Yorkgitis BK, Haines K, Koganti D, Patel N, Maine R, et al. Vaccination after spleen embolization: a practice management guideline from the Eastern Association for the Surgery of Trauma. Injury. 2022;53(11):3569–3574. https://doi.org/10.1016/j.injury.2022.08.006. Systematic review and meta-analysis found that adult patients who underwent splenic angioembolization after trauma had preserved splenic function and therefore do not require post splenectomy vaccines. To date, there has not been definitive evidence regarding timing and need for post-splenectomy (or partial splenectomy) vaccines and these data highlight that splenic function is maintained in non-operative management and reduces the need for vaccine deployment in this patient population.

  71. Schimmer JA, van der Steeg AF, Zuidema WP. Splenic function after angioembolization for splenic trauma in children and adults: a systematic review. Injury. 2016;47(3):525–30. https://doi.org/10.1016/j.injury.2015.10.047.

    Article  CAS  PubMed  Google Scholar 

  72. Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, et al. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S294-300. https://doi.org/10.1097/TA.0b013e3182702afc.

    Article  PubMed  Google Scholar 

  73. Bessoud B, Denys A, Calmes JM, Madoff D, Qanadli S, Schnyder P, et al. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization? AJR Am J Roentgenol. 2006;186(3):779–85. https://doi.org/10.2214/ajr.04.1800.

    Article  PubMed  Google Scholar 

  74. Ko A, Radding S, Feliciano DV, DuBose JJ, Kozar RA, Morrison J, et al. Near disappearance of splenorrhaphy as an operative strategy for splenic preservation after trauma. Am Surg. 2022;88(3):429–33. https://doi.org/10.1177/00031348211050591.

    Article  PubMed  Google Scholar 

  75. Arbuthnot M, Onwubiko C, Mooney D. The lost art of the splenorrhaphy. J Pediatr Surg. 2016;51(11):1881–4. https://doi.org/10.1016/j.jpedsurg.2016.06.020.

    Article  PubMed  Google Scholar 

  76. Lynch JM, Meza MP, Newman B, Gardner MJ, Albanese CT. Computed tomography grade of splenic injury is predictive of the time required for radiographic healing. J Pediatr Surg. 1997;32(7):1093–5. https://doi.org/10.1016/s0022-3468(97)90406-1. (discussion 5-6).

    Article  CAS  PubMed  Google Scholar 

  77. Soffer D, Wiesel O, Schulman CI, Ben Haim M, Klausner JM, Kessler A. Doppler ultrasound for the assessment of conservatively treated blunt splenic injuries: a prospective study. Eur J Trauma Emerg Surg. 2011;37(2):197–202. https://doi.org/10.1007/s00068-010-0044-7.

    Article  CAS  PubMed  Google Scholar 

  78. Zarzaur BL, Kozar RA, Fabian TC, Coimbra R. A survey of American Association for the Surgery of Trauma member practices in the management of blunt splenic injury. J Trauma. 2011;70(5):1026–31. https://doi.org/10.1097/TA.0b013e318217080c.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Yale School of Medicine, New Haven, CT, USA

    Elise Presser, Joshua A. Sznol & Kevin M. Schuster

Authors
  1. Elise Presser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua A. Sznol
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kevin M. Schuster
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JS performed the literature search and assisted in drafting of the manuscript. EP contributed to reviewing the literature and in drafting and editing the manuscript. KS contributed to manuscript drafting, and critical review and editing of the manuscript.

Corresponding author

Correspondence to Kevin M. Schuster.

Ethics declarations

Conflict of interest

The authors did not receive support from any organization for the submitted work. The authors have no relevant financial or non-financial interests to disclose.

Research Involving Human and Animal Rights

This article reviews studies containing human subjects. No institutional board review was applicable or required.

Informed Consent

There are no human subjects directly assessed in this article and informed consent is not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Presser, E., Sznol, J.A. & Schuster, K.M. Management and Outcome of High-Grade Hepatic and Splenic Injuries. Curr Surg Rep 11, 55–63 (2023). https://doi.org/10.1007/s40137-023-00344-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40137-023-00344-1

Keywords

Search

Navigation