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Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol.

Methods

All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48–72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation.

Results

87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14–68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage.

Conclusions

The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.

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Abbreviations

NOM:

Non operative management

AAST:

American association for the surgery of trauma

CT:

Computer tomography

CEUS:

Contrast enhanced ultrasonography

FAST:

Focused assessment sonography for trauma

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Authors and Affiliations

  1. Emergency Department, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

    A. Brillantino & F. Paladino

  2. Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy

    F. Iacobellis

  3. Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

    U. Robustelli, E. Villamaina, O. Colletti, M. De Palma & G. Noschese

  4. Department of Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

    F. Maglione

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  1. A. Brillantino
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Correspondence to A. Brillantino.

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Conflict of interest

Antonio Brillantino, Francesca Iacobellis, Umberto Robustelli, Elisabetta Villamaina, Franco Maglione, Olga Colletti, Maurizio De Palma, Fiorella Paladino and Giuseppe Noschese declare that they have no conflict of interests regarding the publication of this article.

Research involving human participants and/or animals

The study involves Human Participants and the ethical committee of our Institution approved the study protocol.

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All the patients gave informed written consent.

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Brillantino, A., Iacobellis, F., Robustelli, U. et al. Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol. Eur J Trauma Emerg Surg 42, 593–598 (2016). https://doi.org/10.1007/s00068-015-0575-z

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  • DOI: https://doi.org/10.1007/s00068-015-0575-z

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