Abstract
Background
Angioembolization is an effective adjunct to the management of blunt splenic injuries (BSI) that are not surgically treated. However, in some cases patients are unable to undergo angioembolization due to changes in their hemodynamic condition. In this study we attempt to define the characteristics of patients who need angioembolization in high-grade BSI.
Methods
We retrospectively reviewed the charts of patients with BSI between January 2004 and June 2008. Patients with contrast extravasation (CE) on computed tomography (CT) scan were enrolled. The demographics, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), the amount of blood transfused, and the type of CE were analyzed.
Results
A total of 69 patients were enrolled. Patients with intraperitoneal CE in BSI required a higher rate of immediate operation due to changed hemodynamics. Furthermore, these patients displayed higher ISS and higher blood transfusion amounts.
Conclusions
In BSI patients, intraperitoneal CE is associated with a higher possibility of requiring surgical intervention. Early surgical intervention should be considered in BSI patients with intraperitoneal CE or with ISS ≥ 25.
Similar content being viewed by others
References
Esposito TJ, Gamelli RL (2000) Injury to the spleen. In: Feliciano DV, Moore EE, Mattox KL (eds) Trauma. Appleton and Lange, Stamford
Haan JM, Biffl W, Knudson MM et al (2004) Splenic embolization revisited: a multicenter review. J Trauma 56:542–547
Hartnett KL, Winchell RJ, Clark DE (2003) Management of adult splenic injury: a 20-year perspective. Am Surg 69:608–611
Dent D, Alsabrook G, Erickson BA et al (2004) Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization. J Trauma 56:1063–1067
Upadhyaya P (2003) Conservative management of splenic trauma: history and current trends. Pediatr Surg Int 19:617–627
Todd SR, Arthur M, Newgard C et al (2004) Hospital factors associated with splenectomy for splenic injury: a national perspective. J Trauma 57:1065–1071
Galvan DA, Peitzman AB (2006) Failure of nonoperative management of abdominal solid organ injuries. Curr Opin Crit Care 12:590–594
Watson GA, Rosengart MR, Zenati MS et al (2006) Nonoperative management of severe BSI: are we getting better? J Trauma 61:1113–1119
Sclafani SJ, Shaftan GW, Scalea TM et al (1995) Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma 39:818–827
Hagiwara A, Yukioka T, Ohta S et al (1996) Nonsurgical management of patients with BSI: efficacy of transcatheter arterial embolization. AJR Am J Roentgenol 167:159–166
Haan JM, Boswell S, Stein D et al (2007) Follow-up abdominal CT is not necessary in low-grade splenic injury. Am Surg 73:13–18
Rajani RR, Claridge JA, Yowler CJ et al (2006) Improved outcome of adult BSI: a cohort analysis. Surgery 140:625–632
Malangoni MA, Dillon LD, Klamer TW et al (1984) Factors influencing the risk of early and late serious infection in adults after splenectomy for trauma. Surgery 96:775–783
Pachter HL, Guth AA, Hofstetter SR et al (1998) Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg 227:708–717
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
Fang JF, Chen RJ, Lin BC et al (2003) Liver cirrhosis: an unfavorable factor for nonoperative management of blunt splenic injury. J Trauma 54:1131–1136
Bee TK, Croce MA, Miller PR et al (2001) Failures of splenic nonoperative management: is the glass half empty or half full? J Trauma 50:230–236
Malhotra AK, Latifi R, Fabian TC et al (2003) Multiplicity of solid organ injury: influence on management and outcomes after blunt abdominal trauma. J Trauma 54:925–929
Ekiz F, Yucel T, Emergen I et al (2003) The comparison of the results of the conservative treatment between isolated solid organ injuries and those injuries associated with extraabdominal injuries after blunt abdominal trauma. Ulus Travma Acil Cerrahi Derg 9:23–29
Rutledge R, Hunt JP, Lentz CW et al (1995) A statewide, population based time-series analysis of the increasing frequency of nonoperative management of abdominal solid organ injury. Ann Surg 222:311–326
Sartorelli KH, Frumiento C, Rogers FB et al (2000) Nonoperative management of hepatic, splenic and renal injures in adults with multiple injuries. J Trauma 49:56–61
Velmahos GC, Chan LS, Kamel E et al (2000) Nonoperative management of splenic injuries: have we gone too far? Arch Surg 135:674–679 discussion 679–681
Benjamin W, Mark RH, Saman A et al (2008) Angioembolization reduces operative intervention for BSI. J Trauma 64:1472–1477
Stephanie AS, Ben LZ, Louis JM et al (2008) The evolution BSI: resolution and progression. J Trauma 64:1085–1092
Shanmuganathan K, Mirvis SE, Boyd-Kranis R et al (2000) Nonsurgical management of BSI: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology 217:75–82
Yao DC, Jeffrey RB Jr, Mirvis SE et al (2002) Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: incidence and organ distribution. AJR Am J Roentgenol 178:17–20
Fang JF, Chen RJ, Wong YC et al (2000) Classification and treatment of pooling of contrast material on computed tomographic scan of blunt hepatic trauma. J Trauma 49:1083–1088
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fu, CY., Wu, SC., Chen, RJ. et al. Evaluation of Need for Operative Intervention in Blunt Splenic Injury: Intraperitoneal Contrast Extravasation has an Increased Probability of Requiring Operative Intervention. World J Surg 34, 2745–2751 (2010). https://doi.org/10.1007/s00268-010-0723-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-010-0723-x