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Splenic Trauma

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Textbook of Emergency General Surgery

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Abstract

Splenic injuries are among the most frequent trauma-related injuries. The optimal treatment strategy for splenic trauma patients has shifted towards a predominantly nonoperative approach. This has been made possible with close monitoring of the patients and the use of adjuncts such as angioembolization. There is however, still a role for splenectomy in penetrating injuries and in unstable patients. The final management pathway taken, is ultimately based on the physiology of the patient, the anatomy of the injury, and the associated lesions.

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References

  1. Brady RRW, Bandari M, Kerssens JJ, Paterson-Brown S, Parks RW. Splenic trauma in Scotland: demographics and outcomes. World J Surg. 2007;31(11):2111–6.

    Article  PubMed  Google Scholar 

  2. Hartnett KL, Winchell RJ, Clark DE. Management of adult splenic injury: a 20-year perspective. Am Surg. 2003;69(7):608–11.

    Article  PubMed  Google Scholar 

  3. Soo KM, Lin TY, Chen CW, Lin YK, Kuo LC, Wang JY, Lee WC, Lin HL. More becomes less: management strategy has definitely changed over the past decade of splenic injury—a nationwide population-based study. Biomed Res Int. 2015;2015:124969. https://doi.org/10.1155/2015/124969. Epub 2015 Jan 5

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zarzaur BL, Rozycki GS. An update on nonoperative management of the spleen in adults. Trauma Surg Acute Care Open. 2017;2(1):e000075.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yang K, Li Y, Wang C, Xiang B, Chen S, Ji Y. Clinical features and outcomes of blunt splenic injury in children: a retrospective study in a single institution in China. Medicine (Baltimore). 2017;96(51):e9419.

    Article  PubMed  Google Scholar 

  6. Lynn KN, Werder GM, Callaghan RM, Sullivan AN, Jafri ZH, Bloom DA. Pediatric blunt splenic trauma: a comprehensive review. Pediatr Radiol. 2009;39:904–16.

    Article  PubMed  Google Scholar 

  7. Coccolini F, Montori G, Catena F, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017;12:40.

    Article  PubMed  PubMed Central  Google Scholar 

  8. American College of Surgeon’s Commitee on Trauma. Advanced Trauma Life Support® (ATLS®) student manual. 9th ed. Chicago, IL: American College of Surgeon; 2012.

    Google Scholar 

  9. 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;38:433–8.

    Article  CAS  PubMed  Google Scholar 

  10. Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004;57:288–95.

    Article  CAS  PubMed  Google Scholar 

  11. Doody O, Lyburn D, Geoghegan T, Govender P, Monk PM, Torreggiani WC. Blunt trauma to the spleen: ultrasonographic findings. Clin Radiol. 2005;60:968–76.

    Article  CAS  PubMed  Google Scholar 

  12. 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;14:52–8.

    Article  PubMed  Google Scholar 

  13. Bee TK, Croce MA, Miller PR, Pritchard FE, Fabian TC. Failures of splenic nonoperative management: is the glass half empty or half full? J Trauma. 2001;50:230–6.

    Article  CAS  PubMed  Google Scholar 

  14. Clark R, Hird K, Misur P, Ramsay D, Mendelson R. CT grading scales for splenic injury: why can’t we agree? J Med Imaging Radiat Oncol. 2011;55:163–9.

    Article  PubMed  Google Scholar 

  15. Becker CD, Mentha G, Terrier F. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1: liver and spleen. Eur Radiol. 1998;8:553–62.

    Article  CAS  PubMed  Google Scholar 

  16. Shapiro MJ, Krausz C, Durham RM, Mazuski JE. Overuse of splenic scoring and computed tomographic scans. J Trauma. 1999;47:651–8.

    Article  CAS  PubMed  Google Scholar 

  17. Anderson SW, Varghese JC, Lucey BC, P a B, Hirsch EF, J a S. Blunt splenic trauma: delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients. Radiology. 2007;243:88–95.

    Article  PubMed  Google Scholar 

  18. Jeffrey RB, Olcott EW. Imaging of blunt hepatic trauma. Radiol Clin N Am. 1991;29:1299–310.

    Article  PubMed  Google Scholar 

  19. Bhullar IS, Frykberg ER, Tepas JJ, Siragusa D, Loper T, Kerwin AJ. At first blush: absence of computed tomography contrast extravasation in grade IV or V adult blunt splenic trauma should not preclude angioembolization. J Trauma Acute Care Surg. 2013;74:105–11; discussion 111-2

    Article  PubMed  Google Scholar 

  20. Hassan R, Aziz AA, Ralib ARM, Saat A. Computed tomography of blunt spleen injury: a pictorial review. Malaysian J Med Sci. 2011;18:60–7.

    Google Scholar 

  21. Juyia RF, Kerr HA. Return to play after liver and spleen trauma. Sports Health. 2014;6:239–45.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Fernandes TM, Dorigatti AE, Pereira BMT, Cruvinel Neto J, Zago TM, Fraga GP. Nonoperative management of splenic injury grade IV is safe using rigid protocol. Rev Col Bras Cir. 2013;40:323–9.

    Article  PubMed  Google Scholar 

  23. 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:S294–300.

    Article  PubMed  Google Scholar 

  24. Velmahos GC, Toutouzas KG, Radin R, Chan L, Demetriades D. Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg. 2003;138:844–51.

    Article  PubMed  Google Scholar 

  25. Smith J, Armen S, Cook CH, Martin LC. Blunt splenic injuries: have we watched long enough? J Trauma. 2008;64:656–63; discussion 663-5

    PubMed  Google Scholar 

  26. Hafiz S, Desale S, Sava J. The impact of solid organ injury management on the US health care system. J Trauma Acute Care Surg. 2014;77:310–4.

    Article  PubMed  Google Scholar 

  27. Gaspar B, Negoi I, Paun S, Hostiuc S, Ganescu R, Beuran M. Selective nonoperative management of abdominal injuries in polytrauma patients: a protocol only for experienced trauma centers. Maedica. 2014;9:168–72.

    PubMed  PubMed Central  Google Scholar 

  28. Moore FA, Davis JW, Moore EE, Cocanour CS, West MA, McIntyre RC. Western trauma association (WTA) critical decisions in trauma: management of adult blunt splenic trauma. J Trauma. 2008;65:1007–11.

    PubMed  Google Scholar 

  29. 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;82:787–93.

    Article  PubMed  Google Scholar 

  30. Nix JA, Costanza M, Daley BJ, Powell MA, Enderson BL. Outcome of the current management of splenic injuries. J Trauma. 2001;50:835–42.

    Article  CAS  PubMed  Google Scholar 

  31. Peitzman AB, Heil B, Rivera L, Federle M, Harbrecht BG, Clancy K, et al. Blunt splenic injury in adults: multi-institutional study of the Eastern Association for the surgery of trauma. J Trauma Inj Infect Crit Care. 2000;49:177–89.

    Article  CAS  Google Scholar 

  32. Malhotra AK, Latifi R, Fabian TC, Ivatury RR, Dhage S, Bee TK, et al. Multiplicity of solid organ injury: influence on management and outcomes after blunt abdominal trauma. J Trauma. 2003;54:925–9.

    Article  PubMed  Google Scholar 

  33. Velmahos GC, Zacharias N, Emhoff TA, Feeney JM, Hurst JM, Crookes BA, et al. Management of the most severely injured spleen: a multicenter study of the research consortium of New England centers for trauma (ReCONECT). Arch Surg. 2010;145:456–60.

    Article  PubMed  Google Scholar 

  34. Jeremitsky E, Kao A, Carlton C, Rodriguez A, Ong A. Does splenic embolization and grade of splenic injury impact nonoperative management in patients sustaining blunt splenic trauma? Am Surg. 2011;77:215–20.

    Article  PubMed  Google Scholar 

  35. Watson GA, Rosengart MR, Zenati MS, Tsung A, Forsythe RM, Peitzman AB, et al. Nonoperative management of severe blunt splenic injury: are we getting better? J Trauma. 2006;61(5):1113–8; discussion 1118-9

    Article  PubMed  Google Scholar 

  36. Schurr MJ, Fabian TC, Gavant M, Croce MA, Kudsk KA, Minard G, et al. Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma. 1995;39(3):507–12; discussion 512-3

    Article  CAS  PubMed  Google Scholar 

  37. 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;43:1337–46.

    Article  PubMed  Google Scholar 

  38. Aseervatham R, Muller M. Blunt trauma to the spleen. Aust N Z J Surg. 2000;70:333–7.

    Article  CAS  PubMed  Google Scholar 

  39. Crawford RS, Tabbara M, Sheridan R, Spaniolas K, Velmahos GC. Early discharge after nonoperative management for splenic injuries: increased patient risk caused by late failure? Surgery. 2007;142:337–42.

    Article  PubMed  Google Scholar 

  40. Jeremitsky E, Smith RS, Ong AW. Starting the clock: defining nonoperative management of blunt splenic injury by time. Am J Surg. 2013;205:298–301.

    Article  PubMed  Google Scholar 

  41. Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg. 1987;205:129–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Velmahos GC, Demetriades D, Toutouzas KG, Sarkisyan G, Chan LS, Ishak R, et al. Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care? Ann Surg. 2001;234(3):395–402; discussion 402-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. 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 

  44. Renz BM, Feliciano DV. Gunshot wounds to the right thoracoabdomen: a prospective study of nonoperative management. J Trauma. 1994;37:737–44.

    Article  CAS  PubMed  Google Scholar 

  45. Inaba K, Barmparas G, Foster A, Talving P, David J-S, Green D, et al. Selective nonoperative management of torso gunshot wounds: when is it safe to discharge? J Trauma. 2010;68:1301–4.

    PubMed  Google Scholar 

  46. Haan JM, Bochicchio GV, Kramer N, Scalea TM. Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma. 2005;58:492–8.

    Article  PubMed  Google Scholar 

  47. Haan J, Scott J, Boyd-Kranis RL, Ho S, Kramer M, Scalea TM. Admission angiography for blunt splenic injury: advantages and pitfalls. J Trauma. 2001;51:1161–5.

    CAS  PubMed  Google Scholar 

  48. Haan JM, Biffl W, Knudson MM, Davis KA, Oka T, Majercik S, et al. Splenic embolization revisited: a multicenter review. J Trauma Inj Infect Crit Care. 2004;56:542–7.

    Article  Google Scholar 

  49. Frandon J, Rodière M, Arvieux C, Michoud M, Vendrell A, Broux C, et al. Blunt splenic injury: outcomes of proximal versus distal and combined splenic artery embolization. Diagn Interv Imaging. 2014;95:825–31.

    Article  CAS  PubMed  Google Scholar 

  50. Schnüriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma. 2011;70:252–60.

    PubMed  Google Scholar 

  51. Tugnoli G, Bianchi E, Biscardi A, Coniglio C, Isceri S, Simonetti L, et al. Nonoperative management of blunt splenic injury in adults: there is (still) a long way to go. The results of the Bologna-Maggiore Hospital trauma center experience and development of a clinical algorithm. Surg Today. 2015;45:1210–7.

    Article  PubMed  Google Scholar 

  52. 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? Am J Roentgenol. 2006;186:779–85.

    Article  Google Scholar 

  53. Brillantino A, Iacobellis F, Robustelli U, Villamaina E, Maglione F, Colletti O, et al. Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol. Eur J Trauma Emerg Surg. 2016;42:593–8.

    Article  CAS  PubMed  Google Scholar 

  54. Smith HE, Biffl WL, Majercik SD, Jednacz J, Lambiase R, Cioffi WG. Splenic artery embolization: have we gone too far? J Trauma. 2006;61:541–4; discussion 545-6

    Article  PubMed  Google Scholar 

  55. Capecci LM, Jeremitsky E, Smith RS, Philp F. Trauma centers with higher rates of angiography have a lesser incidence of splenectomy in the management of blunt splenic injury. Surgery. 2015;158:1020–4; discussion 1024-6

    Article  PubMed  Google Scholar 

  56. Zarzaur BL, Savage SA, Croce MA, Fabian TC. Trauma center angiography use in high-grade blunt splenic injuries: timing is everything. J Trauma Acute Care Surg. 2014;77:666–71.

    Article  PubMed  Google Scholar 

  57. Raikhlin A, Baerlocher MO, Asch MR, Myers A. Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature. Can J Surg. 2008;51:464–72.

    PubMed  PubMed Central  Google Scholar 

  58. Banerjee A, Duane TM, Wilson SP, Haney S, O’Neill PJ, Evans HL, et al. Trauma center variation in splenic artery embolization and spleen salvage: a multicenter analysis. J Trauma Acute Care Surg. 2013;75:69–74; discussion 74-5

    Article  PubMed  Google Scholar 

  59. Rosati C, Ata A, Siskin GP, Megna D, Bonville DJ, Stain SC. Management of splenic trauma: a single institution’s 8-year experience. Am J Surg. 2015;209:308–14.

    Article  PubMed  Google Scholar 

  60. 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 Inj Infect Crit Care. 2011;71:898–903.

    Google Scholar 

  61. Davis KA, Fabian TC, Croce MA, Gavant ML, Flick PA, Minard G, et al. Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms. J Trauma. 1998;44:1008–13; discussion 1013-5

    Article  CAS  PubMed  Google Scholar 

  62. Dehli T, Bagenholm A, Trasti NC, Monsen SA, Bartnes K, Bågenholm A, et al. The treatment of spleen injuries: a retrospective study. Scand J Trauma Resusc Emerg Med. 2015;23:85.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Yuan K-C, Wong Y-C, Lin B-C, Kang S-C, Liu E-H, Hsu Y-P. Negative catheter angiography after vascular contrast extravasations on computed tomography in blunt torso trauma: an experience review of a clinical dilemma. Scand J Trauma Resusc Emerg Med. 2012;20:46.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Alarhayem AQ, Myers JG, Dent D, Lamus D, Lopera J, Liao L, et al. “Blush at first sight”: significance of computed tomographic and angiographic discrepancy in patients with blunt abdominal trauma. Am J Surg. 2015;210:1104. s

    Article  PubMed  Google Scholar 

  65. Gavant ML, Schurr M, Flick PA, Croce MA, Fabian TC, Gold RE. Predicting clinical outcome of nonsurgical management of blunt splenic injury: using CT to reveal abnormalities of splenic vasculature. Am J Roentgenol. 1997;168:207–12.

    Article  CAS  Google Scholar 

  66. Skattum J, Naess PA, Eken T, Gaarder C. Refining the role of splenic angiographic embolization in high-grade splenic injuries. J Trauma Acute Care Surg. 2013;74:100–3; discussion 103-4

    Article  PubMed  Google Scholar 

  67. Miller PR, Chang MC, Hoth JJ, Mowery NT, Hildreth AN, Martin RS, 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;218:644–8.

    Article  PubMed  Google Scholar 

  68. Chastang L, Bège T, Prudhomme M, Simonnet AC, Herrero A, Guillon F, et al. Is non-operative management of severe blunt splenic injury safer than embolization or surgery? Results from a French prospective multicenter study. J Visc Surg. 2015;152:85–91.

    Article  CAS  PubMed  Google Scholar 

  69. Ekeh AP, McCarthy MC, Woods RJ, Haley E. Complications arising from splenic embolization after blunt splenic trauma. Am J Surg. 2005;189:335–9.

    Article  PubMed  Google Scholar 

  70. Frandon J, Rodiere M, Arvieux C, Vendrell A, Boussat B, Sengel C, et al. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery? Diagnostic Interv Radiol. 2015;21:327–33.

    Article  Google Scholar 

  71. Demetriades D, Scalea TM, Degiannis E, Barmparas G, Konstantinidis A, Massahis J, et al. Blunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study. J Trauma Acute Care Surg. 2012;72:229–34.

    Article  PubMed  Google Scholar 

  72. Kaseje N, Agarwal S, Burch M, Glantz A, Emhoff T, Burke P, et al. Short-term outcomes of splenectomy avoidance in trauma patients. Am J Surg. 2008;196:213–7.

    Article  PubMed  Google Scholar 

  73. Freitas G, Olufajo OA, Hammouda K, Lin E, Cooper Z, Havens JM, et al. Postdischarge complications following nonoperative management of blunt splenic injury. Am J Surg. 2016;211:744–9.

    Article  PubMed  Google Scholar 

  74. Wei B, Hemmila MR, Arbabi S, Taheri PA, Wahl WL, et al. Angioembolization reduces operative intervention for blunt splenic injury. J Trauma Inj Infect Crit Care. 2008;64:1472–7.

    Google Scholar 

  75. 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;205:250–4.

    Article  PubMed  Google Scholar 

  76. Wu SC, Chen RJ, Yang AD, Tung CC, Lee KH. Complications associated with embolization in the treatment of blunt splenic injury. World J Surg. 2008;32:476–82.

    Article  PubMed  Google Scholar 

  77. 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;45:1409–12.

    Article  PubMed  Google Scholar 

  78. Morrell DG, Chang FC, Helmer SD. Changing trends in the management of splenic injury. Am J Surg. 1995;170:686–9; discussion 690

    Article  CAS  PubMed  Google Scholar 

  79. Carter JW, Falco MH, Chopko MS, Flynn WJ, Wiles Iii CE, Guo WA. Do we really rely on fast for decision-making in the management of blunt abdominal trauma? Injury. 2015;46:817–21.

    Article  PubMed  Google Scholar 

  80. Garber BG, Yelle JD, Fairfull-Smith R, Lorimer JW, Carson C. Management of splenic injuries in a Canadian trauma centre. Can J Surg. 1996;39:474–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Garber BG, Mmath BP, Fairfull-Smith RJ, Yelle JD. Management of adult splenic injuries in Ontario: a population-based study. Can J Surg. 2000;43:283–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  82. Pisters PW, Pachter HL. Autologous splenic transplantation for splenic trauma. Ann Surg. 1994;219:225–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Qu Y, Ren S, Li C, Qian S, Liu P. Management of postoperative complications following splenectomy. Int Surg. 2013;98:55–60.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Nasr WI, Collins CL, Kelly JJ. Feasibility of laparoscopic splenectomy in stable blunt trauma: a case series. J Trauma. 2004;57:887–9.

    Article  PubMed  Google Scholar 

  85. Hallfeldt KK, Trupka AW, Erhard J, Waldner H, Schweiberer L. Emergency laparoscopy for abdominal stab wounds. Surg Endosc. 1998;12:907–10.

    Article  CAS  PubMed  Google Scholar 

  86. Rostas JW, Manley J, Gonzalez RP, Brevard SB, Ahmed N, Frotan MA, et al. The safety of low molecular-weight heparin after blunt liver and spleen injuries. Am J Surg. 2015;210:31–4.

    Article  PubMed  Google Scholar 

  87. Murphy PB, Sothilingam N, Charyk Stewart T, Batey B, Moffat B, Gray DK, et al. Very early initiation of chemical venous thromboembolism prophylaxis after blunt solid organ injury is safe. Can J Surg. 2016;59:118–22.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Alejandro KV, Acosta JA, Rodríguez PA. Bleeding manifestations after early use of low-molecular-weight heparins in blunt splenic injuries. Am Surg. 2003;69:1006–9.

    Article  PubMed  Google Scholar 

  89. 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;209:194–8.

    Article  PubMed  Google Scholar 

  90. Weinberger J, Cipolle M. Optimal reversal of novel anticoagulants in trauma. Crit Care Clin. 2017;33:135–52.

    Article  PubMed  Google Scholar 

  91. Zarzaur BL, Vashi S, Magnotti LJ, Croce MA, Fabian TC. The real risk of splenectomy after discharge home following nonoperative management of blunt splenic injury. J Trauma. 2009;66:1531–8.

    PubMed  Google Scholar 

  92. Savage SA, Zarzaur BL, Magnotti LJ, Weinberg JA, Maish GO, Bee TK, et al. The evolution of blunt splenic injury: resolution and progression. J Trauma. 2008;64:1085–91; discussion 1091-2

    PubMed  Google Scholar 

  93. Meguid AA, Bair HA, Howells GA, Bendick PJ, Kerr HH, Villalba MR. Prospective evaluation of criteria for the nonoperative management of blunt splenic trauma. Am Surg. 2003;69:238–42; discussion 242-3

    Article  PubMed  Google Scholar 

  94. Riezzo I, Di Battista B, De Salvia A, Cantatore S, Neri M, Pomara C, et al. Delayed splenic rupture: dating the sub-capsular hemorrhage as a useful task to evaluate causal relationships with trauma. Forensic Sci Int. 2014;234:64–71.

    Article  PubMed  Google Scholar 

  95. Clancy AA, Tiruta C, Ashman D, Ball CG, Kirkpatrick AW. The song remains the same although the instruments are changing: complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a level I trauma Centre from 1996 to 2007. J Trauma Manag Outcomes. 2012;6:4.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Haan JM, Boswell S, Stein D, Scalea TM. Follow-up abdominal CT is not necessary in low-grade splenic injury. Am Surg. 2007;73:13–8.

    Article  PubMed  Google Scholar 

  97. Muroya T, Ogura H, Shimizu K, Tasaki O, Kuwagata Y, Fuse T, et al. Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury: multi-institutional study in Osaka, Japan. J Trauma Acute Care Surg. 2013;75:417–20.

    Article  PubMed  Google Scholar 

  98. Uecker J, Pickett C, Dunn E. The role of follow-up radiographic studies in nonoperative management of spleen trauma. Am Surg. 2001;67:22–5.

    Article  CAS  PubMed  Google Scholar 

  99. Lyass S, Sela T, Lebensart PD, Muggia-Sullam M. Follow-up imaging studies of blunt splenic injury: do they influence management? Isr Med Assoc J. 2001;3:731–3.

    CAS  PubMed  Google Scholar 

  100. 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;32:1093–6.

    Article  CAS  PubMed  Google Scholar 

  101. Unal E, Onur MR, Akpinar E, Ahmadov J, Karcaaltincaba M, Ozmen MN, et al. Imaging findings of splenic emergencies: a pictorial review. Insights Imaging. 2016;7:215–22.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Linet MS, Nyrén O, Gridley G, Adami HO, Buckland JD, McLaughlin JK, et al. Causes of death among patients surviving at least one year following splenectomy. Am J Surg. 1996;172:320–3.

    Article  CAS  PubMed  Google Scholar 

  103. Alonso M, Brathwaite C, García V, Patterson L, Scherer T, Stafford P, et al. Practice management guidelines for the nonoperative management of blunt injury to the liver and spleen. Chicago, IL: Eastern Association for the Surgery of Trauma; 2003.

    Google Scholar 

  104. Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38:323–4.

    Article  CAS  PubMed  Google Scholar 

  105. Bairdain S, Litman HJ, Troy M, McMahon M, Almodovar H, Zurakowski D, et al. Twenty-years of splenic preservation at a level 1 pediatric trauma center. J Pediatr Surg. 2015;50:864–8.

    Article  PubMed  Google Scholar 

  106. Stylianos S. Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA trauma committee. J Pediatr Surg. 2000;35:164–9.

    Article  CAS  PubMed  Google Scholar 

  107. McVay MR, Kokoska ER, Jackson RJ, Smith SD. Throwing out the “grade” book: management of isolated spleen and liver injury based on hemodynamic status. J Pediatr Surg. 2008;43:1072–6.

    Article  PubMed  Google Scholar 

  108. Martin K, Vanhouwelingen L, Bütter A. The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma. J Pediatr Surg. 2011;46:933–7.

    Article  PubMed  Google Scholar 

  109. Li D, Yanchar N. Management of pediatric blunt splenic injuries in Canada-practices and opinions. J Pediatr Surg. 2009;44:997–1004.

    Article  PubMed  Google Scholar 

  110. Bond SJ, Eichelberger MR, Gotschall CS, Sivit CJ, Randolph JG. Nonoperative management of blunt hepatic and splenic injury in children. Ann Surg. 1996;223:286–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. Muehrcke DD, Kim SH, McCabe CJ. Pediatric splenic trauma: predicting the success of nonoperative therapy. Am J Emerg Med. 1987;5:109–12.

    Article  CAS  PubMed  Google Scholar 

  112. Delius RE, Frankel W, Coran AG. A comparison between operative and nonoperative management of blunt injuries to the liver and spleen in adult and pediatric patients. Surgery. 1989;106:788–92; discussion 792-3

    CAS  PubMed  Google Scholar 

  113. Lynch JM, Ford H, Gardner MJ, Weiner ES. Is early discharge following isolated splenic injury in the hemodynamically stable child possible? J Pediatr Surg. 1993;28:1403–7.

    Article  CAS  PubMed  Google Scholar 

  114. Konstantakos AK, Barnoski AL, Plaisier BR, Yowler CJ, Fallon WF, Malangoni MA. Optimizing the management of blunt splenic injury in adults and children. Surgery. 1999;126:805–13.

    Article  CAS  PubMed  Google Scholar 

  115. Upadhyaya P. Conservative management of splenic trauma: history and current trends. Pediatr Surg Int. 2003;19:617–27.

    Article  CAS  PubMed  Google Scholar 

  116. Rodrigues CJ, Sacchetti JC, Rodrigues AJ. Age-related changes in the elastic fiber network of the human splenic capsule. Lymphology. 1999;32:64–9.

    CAS  PubMed  Google Scholar 

  117. Murphy R, Ghosh A. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. The accuracy of abdominal ultrasound in paediatric trauma. Emerg Med J. 2001;18:208–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  118. Scaife ER, Rollins MD, Barnhart DC, Downey EC, Black RE, Meyers RL, et al. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg. 2013;48:1377–83.

    Article  PubMed  Google Scholar 

  119. Holmes JF, Gladman A, Chang CH. Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg. 2007;42:1588–94.

    Article  PubMed  Google Scholar 

  120. Mooney DP, Rothstein DH, Forbes PW. Variation in the management of pediatric splenic injuries in the United States. J Trauma Inj Infect Crit Care. 2006;61:330–3.

    Article  Google Scholar 

  121. Todd SR, Arthur M, Newgard C, Hedges JR, Mullins RJ. Hospital factors associated with splenectomy for splenic injury: a national perspective. J Trauma. 2004;57:1065–71.

    Article  PubMed  Google Scholar 

  122. Notrica DM, Eubanks JW, Tuggle DW, Maxson RT, Letton RW, Garcia NM, et al. Nonoperative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 2015;79:683–93.

    Article  PubMed  Google Scholar 

  123. Narci A, Solak O, Turhan-Haktanir N, Ayçiçek A, Demir Y, Ela Y, et al. The prognostic importance of trauma scoring systems in pediatric patients. Pediatr Surg Int. 2009;25:25–30.

    Article  PubMed  Google Scholar 

  124. Richards JR, McGahan JP, Jones CD, Zhan S, Gerscovich EO. Ultrasound detection of blunt splenic injury. Injury. 2001;32:95–103.

    Article  CAS  PubMed  Google Scholar 

  125. Tataria M, Nance ML, Holmes JH 4th, Miller CC 3rd, Mattix KD, Brown RL, et al. Pediatric blunt abdominal injury: age is irrelevant and delayed operation is not detrimental. J Trauma. 2007;63:608–14.

    PubMed  Google Scholar 

  126. Holmes JH 4th, Wiebe DJ, Tataria M, Mattix KD, Mooney DP, Scaife ER, et al. The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience. J Trauma. 2005;59:1309–13.

    Article  PubMed  Google Scholar 

  127. Sharma OP, Oswanski MF, Singer D, Raj SS, Daoud YAH. Assessment of nonoperative management of blunt spleen and liver trauma. Am Surg. 2005;71:379–86.

    Article  PubMed  Google Scholar 

  128. McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg. 2005;140:563–8; discussion 568

    Article  PubMed  Google Scholar 

  129. Cloutier DR, Baird TB, Gormley P, McCarten KM, Bussey JG, Luks FI. Pediatric splenic injuries with a contrast blush: successful nonoperative management without angiography and embolization. J Pediatr Surg. 2004;39:969–71.

    Article  PubMed  Google Scholar 

  130. Gross JL, Woll NL, Hanson CA, Pohl C, Scorpio RJ, Kennedy AP Jr, et al. Embolization for pediatric blunt splenic injury is an alternative to splenectomy when observation fails. J Trauma Acute Care Surg. 2013;75:421–5.

    Article  PubMed  Google Scholar 

  131. Kiankhooy A, Sartorelli KH, Vane DW, Bhave AD. Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children. J Trauma. 2010;68:526–31.

    PubMed  Google Scholar 

  132. Skattum J, Gaarder C, Naess PA. Splenic artery embolisation in children and adolescents—an 8 year experience. Injury. 2014;45:160–3.

    Article  PubMed  Google Scholar 

  133. Mayglothling JA, Haan JM, Scalea TM. Blunt splenic injuries in the adolescent trauma population: the role of angiography and embolization. J Emerg Med. 2011;41:21–8.

    Article  PubMed  Google Scholar 

  134. Schuster T, Leissner G. Selective angioembolization in blunt solid organ injury in children and adolescents: review of recent literature and own experiences. Eur J Pediatr Surg. 2013;23:454–63.

    Article  PubMed  Google Scholar 

  135. van der Vlies CH, Saltzherr TP, Wilde JCH, van Delden OM, de Haan RJ, Goslings JC. The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review. J Pediatr Surg. 2010;45:1044–9.

    Article  PubMed  Google Scholar 

  136. Ben-Ishay O, Gutierrez IM, Pennington EC, Mooney DP. Transarterial embolization in children with blunt splenic injury results in postembolization syndrome: a matched case-control study. J Trauma Acute Care Surg. 2012;73:1558–63.

    Article  PubMed  Google Scholar 

  137. Akinkuolie AA, Lawal OO, Arowolo OA, Agbakwuru EA, Adesunkanmi ARK. Determinants of splenectomy in splenic injuries following blunt abdominal trauma. S Afr J Surg. 2010;48:15–9.

    CAS  PubMed  Google Scholar 

  138. Polites SF, Zielinski MD, Zarroug AE, Wagie AE, Stylianos S, Habermann EB. Benchmarks for splenectomy in pediatric trauma: how are we doing? J Pediatr Surg. 2015;50:339–42.

    Article  PubMed  Google Scholar 

  139. Nwomeh BC, Nadler EP, Meza MP, Bron K, Gaines BA, Ford HR. Contrast extravasation predicts the need for operative intervention in children with blunt splenic trauma. J Trauma. 2004;56:537–41.

    Article  PubMed  Google Scholar 

  140. Jen HC, Tillou A, Cryer HG, Shew SB. Disparity in management and long-term outcomes of pediatric splenic injury in California. Ann Surg. 2010;251:1162–6.

    Article  PubMed  Google Scholar 

  141. Mohamed AA, Mahran KM, Zaazou MM. Blunt abdominal trauma requiring laparotomy in polytraumatized patients. Saudi Med J. 2010;31:43–8.

    PubMed  Google Scholar 

  142. Lo A, Matheson A-M, Adams D. Impact of concomitant trauma in the management of blunt splenic injuries. N Z Med J. 2004;117:U1052.

    PubMed  Google Scholar 

  143. Resende V, Petroianu A. Functions of the splenic remnant after subtotal splenectomy for treatment of severe splenic injuries. Am J Surg. 2003;185:311–5.

    Article  PubMed  Google Scholar 

  144. Keller MS, Sartorelli KH, Vane DW. Associated head injury should not prevent nonoperative management of spleen or liver injury in children. J Trauma. 1996;41:471–5.

    Article  CAS  PubMed  Google Scholar 

  145. St Peter SD, Aguayo P, Juang D, Sharp SW, Snyder CL, Holcomb GW, et al. Follow up of prospective validation of an abbreviated bedrest protocol in the management of blunt spleen and liver injury in children. J Pediatr Surg. 2013;48:2437–41.

    Article  PubMed  Google Scholar 

  146. Minarik L, Slim M, Rachlin S, Brudnicki A. Diagnostic imaging in the follow-up of nonoperative management of splenic trauma in children. Pediatr Surg Int. 2002;18:429–31.

    Article  PubMed  Google Scholar 

  147. Pachter HL, Guth AA, Hofstetter SR, Spencer FC. Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg. 1998;227:708–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  148. Zabolotny B, Hancock BJ, Postuma R, Wiseman N. Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline. Can J Surg. 2002;45:358–62.

    PubMed  PubMed Central  Google Scholar 

  149. Leone G, Pizzigallo E. Bacterial infections following splenectomy for malignant and nonmalignant hematologic diseases. Mediterr J Hematol Infect Dis. 2015:7.

    Google Scholar 

  150. Skattum J, P a N, Gaarder C. Non-operative management and immune function after splenic injury. Br J Surg. 2012;99(Suppl 1):59–65.

    PubMed  Google Scholar 

  151. Shatz DV. Vaccination practices among North American trauma surgeons in splenectomy for trauma. J Trauma. 2002;53:950–6.

    Article  PubMed  Google Scholar 

  152. Shatz DV, Romero-Steiner S, Elie CM, Holder PF, Carlone GM. Antibody responses in postsplenectomy trauma patients receiving the 23-valent pneumococcal polysaccharide vaccine at 14 versus 28 days postoperatively. J Trauma. 2002;53:1037–42.

    Article  CAS  PubMed  Google Scholar 

  153. ACIP Vaccine Recommendations. Centers for disease control and prevention, recommended immunization schedules, 2016.

    Google Scholar 

  154. Spelman D, Buttery J, Daley A, Isaacs D, Jennens I, Kakakios A, et al. Guidelines for the prevention of sepsis in asplenic and hyposplenic patients. Intern Med J. 2008;38:349–56.

    Article  CAS  PubMed  Google Scholar 

  155. Salvadori MI, Price VE. Preventing and treating infections in children with asplenia or hyposplenia. Paediatr Child Heal. 2014;19:271–4.

    Article  Google Scholar 

  156. Schimmer JAG, Van Der Steeg AFW, Zuidema WP. Splenic function after angioembolization for splenic trauma in children and adults: a systematic review. Injury. 2016;47:525–30.

    Article  CAS  PubMed  Google Scholar 

Further Reading

  • Coccolini, F., Montori, G., Catena, F. et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 12, 40 Thursday (2017).

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Authors and Affiliations

  1. Department of General Surgery, Singapore General Hospital, Singapore, Singapore

    Tian Wei Cheng Brian Anthony

  2. Department of General, Acute Care and Trauma Surgery, Bufalini Hospital, Cesena, Italy

    Carlo Vallicelli & Fausto Catena

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  1. Tian Wei Cheng Brian Anthony
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  2. Carlo Vallicelli
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  3. Fausto Catena
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Correspondence to Tian Wei Cheng Brian Anthony .

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Editors and Affiliations

  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

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Anthony, T.W.C.B., Vallicelli, C., Catena, F. (2023). Splenic Trauma. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_96

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