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Splenic Injury

Injury to Spleen


Presentation

  • Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105-130), hypotension and/or a rapid drop in hemoglobin levels.[ncbi.nlm.nih.gov]
  • Although this is a rare complication of SWL, with only eight published cases found in the literature, the patient's initial presentation of syncope without complaints of abdominal pain presented a unique diagnostic challenge.[ncbi.nlm.nih.gov]
  • She presented to hospital 6 weeks after the procedure with dyspnoea and hypoxia.[ncbi.nlm.nih.gov]
  • We report an unusual presentation of a splenic injury in a young man who had symptoms only in the supine position.[ncbi.nlm.nih.gov]
  • All patients undergoing delayed laparotomy for HVI or a splenic procedure presented symptomatically within 24h of the initial injury. No deaths occurred in patients undergoing NOM.[ncbi.nlm.nih.gov]
Asymptomatic
  • One patient was asymptomatic, the second developed left upper quadrant pain, and the third required emergency splenectomy.[ncbi.nlm.nih.gov]
  • He experienced gradually worsening difficulty breathing while sitting or lying down for the previous 4 h, although he was asymptomatic in the upright position.[ncbi.nlm.nih.gov]
  • In addition, they tend to be very insidious and asymptomatic in the beginning. The spleen is an organ located in the abdominal cavity under the left costal arch.[health-tutor.com]
Plethora
  • CONCLUSION: There has been a plethora of literature regarding nonoperative management of blunt splenic injuries published since the original EAST practice management guideline was written.[ncbi.nlm.nih.gov]
Noncompliance
  • Indirect supervision was associated with a greater use of intensive care unit (ICU) resources and protocol noncompliance with the use of splenic artery embolization. The overall success of NOM was 98.6%.[ncbi.nlm.nih.gov]
Splenomegaly
  • Any cause of increased splenocolic adhesions, splenomegaly, or underlying splenic disease might be a predisposing factor for splenic injury during colonoscopy.[ncbi.nlm.nih.gov]
  • However, patients with splenomegaly due to anemia like the one discussed above are more vulnerable to splenic trauma.[e-ultrasonography.org]
  • See also [ edit ] Splenomegaly Kehr's sign References [ edit ] Aubrey-Bassler, F.; Sowers, N. (2012). "613 cases of splenic rupture without risk factors or previously diagnosed disease: A systematic review".[en.wikipedia.org]
  • Patients typically present within hours to several days after the procedure with abdominal pain and symptoms of hemodynamic instability. 1 Possible predisposing factors include adhesions involving the splenocolic ligaments, splenomegaly, looping at the[aafp.org]
  • ., in cases of splenomegaly caused by malaria, mononucleosis, hematological illness) Iatrogenic ( post-surgery or post-endoscopy ) References: [1] Classification Classification of splenic injury Grade I (minor injury, e.g., subcapsular tear) to Grade[amboss.com]
Left Upper Quadrant Pain
  • One patient was asymptomatic, the second developed left upper quadrant pain, and the third required emergency splenectomy.[ncbi.nlm.nih.gov]
  • The most common symptom was left upper quadrant pain (58 %), and CT scan was found to be the most sensitive tool for diagnosis. Seventy-three patients underwent operative intervention; 96 % of these were treated with splenectomy.[ncbi.nlm.nih.gov]
  • Case Report A 14-year-old boy presented to the Emergency Department of our hospital complaining of left upper quadrant pain after an accident during which he fell onto his bicycle’s handlebars.[e-ultrasonography.org]

Workup

  • Workup included a testicular ultrasound scan with colorflow Doppler as well as abdominal and pelvic computerized tomography.[ncbi.nlm.nih.gov]
  • […] traumatic pseudoaneurysm, moderate hemoperitoneum, evidence of ongoing splenic bleeding requiring blood transfusion, arteriovenous fistula, and evidence of active extravasation suggested by contrast blush on CT. 4,5,6,7,8,9 All blunt trauma patients undergo workup[uktraumaprotocol.blogspot.com]
  • If the patient has a normal pulse rate and blood pressure, then workup can proceed to CT scanning with IV contrast to determine whether a “blush” of “extravasated contrast” is present.[jlgh.org]

Treatment

  • The literature on nonoperative treatment of such injuries is discussed. The present authors remain in favor of operative treatment of proven cases of splenic injury.[ncbi.nlm.nih.gov]
  • In the embolization group, 1 (7%) of 15 failed initial treatment and underwent splenectomy.[ncbi.nlm.nih.gov]
  • Demographic data, vital signs, laboratory values, injury severity score, abbreviated injury severity, final treatment decision, and success of nonsurgical treatment were reviewed.[ncbi.nlm.nih.gov]
  • Except for haemodynamic instability, reported predictors of failure of conservative treatment should not be seen as absolute contraindications to this approach.[ncbi.nlm.nih.gov]
  • Successful treatment was defined as splenic salvage and no splenic re-intervention.[ncbi.nlm.nih.gov]

Prognosis

  • Moreover, the hypothesis that incidental splenectomy carries a worse prognosis deserves attention.[ncbi.nlm.nih.gov]
  • […] lobulation of the spleen after development in contrast to a laceration, a cleft is usually smooth with a rounded edge and are not associated with an adjacent subcapsular hematoma or perisplenic fluid some larger clefts may contain fat Treatment and prognosis[radiopaedia.org]
  • Although currently lacking comparative and larger studies, preventive spleen embolization seems to have potential in high-grade trauma and/or in patients who have high-risk prognosis factors (eg, age 50 years, polytraumatism, intraperitoneal bleeding,[evtoday.com]
  • Prognosis The ample blood supply to the spleen can promote rapid healing. Studies have shown that intra-abdominal bleeding associated with splenic trauma stops without surgical intervention in up to two out of three cases in children.[medical-dictionary.thefreedictionary.com]
  • […] hospitalization -Prescribed a 6 month recovery before returning to hockey -At 2 months-light to medium physical activity and a CT scan -At 4 months- follow up assessment, intense physical noncontact training began -At 6 months- full contact was permitted Prognosis[physio-pedia.com]

Etiology

  • Etiology Blunt abdominal trauma Most frequently caused by m otor vehicle accidents leading to liver and spleen injury Also caused by falls from high heights ;, domestic violence, and sport-related trauma Other causes Left-sided thoracic trauma with fractures[amboss.com]
  • Back Home Splenic Trauma (Penetrating) Background Definition Injury to the spleen due to penetrating trauma Etiology Gunshot wounds Stab wounds Other implements A delayed threat to life Pathophysiology Spleen receives 5% of cardiac output Mostly through[fprmed.com]
  • Laceration of greater than 3 cm in depth or involving trabecular vessels. [15] Grade V - Shattered spleen or hilar vascular injury [15] Etiology/Causes Traumatic (common) [3] • Injury or blow to left side of the body (left upper abdomen or left lower[physio-pedia.com]

Epidemiology

  • The epidemiology and validation of the spleen injury CPG were analyzed. METHODS: The Joint Theater Trauma Registry was queried for splenic injury from 2001 to 2010.[ncbi.nlm.nih.gov]
  • LEVEL OF EVIDENCE: Epidemiologic study, level III.[ncbi.nlm.nih.gov]
  • Data abstracted included patient demographics, injury epidemiology, grade of splenic injury, treatment and outcome. These data were compared with a registry database from a UK civilian major trauma centre.[ncbi.nlm.nih.gov]
  • BACKGROUND: Splenic injury frequently occurs after blunt abdominal trauma; however, limited epidemiological data regarding mortality are available. We aimed to investigate mortality rate trends after blunt splenic injury in Japan.[ncbi.nlm.nih.gov]
  • LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III; therapeutic study, level IV.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • […] splenic salvage maneuver Grade IV Fragmented spleen with major devascularization Surgical intervention: splenectomy, a partial splenic resection if possible Grade V Hilar laceration/shattered spleen Surgical intervention: splenectomy References: [2] Pathophysiology[amboss.com]
  • Back Home Splenic Trauma (Penetrating) Background Definition Injury to the spleen due to penetrating trauma Etiology Gunshot wounds Stab wounds Other implements A delayed threat to life Pathophysiology Spleen receives 5% of cardiac output Mostly through[fprmed.com]
  • […] by the pediatric experience with successful non-operative management (NOM), an understanding of the intact spleen’s vital role in healthy immune function, and the use of more detailed diagnostic modalities to further delineate the extent of injury. 2 PATHOPHYSIOLOGY[jlgh.org]

Prevention

  • Establishing a vaccination tracking system and following vaccination recommendations will be helpful to prevent serious infections, such as OPSI, after traumatic splenectomy.[ncbi.nlm.nih.gov]
  • Proximal preventive embolization appears to protect in high-grade traumatic injuries. Copyright 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.[ncbi.nlm.nih.gov]
  • Mandatory immunization to prevent severe infections does not seem warranted. Copyright 2012 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Significant resources, including angiography (ANGIO), are used in an effort to prevent delayed splenectomy (DS). No prospective, long-term data exist to determine the actual risk of splenectomy.[ncbi.nlm.nih.gov]
  • Patients whose spleens have been removed must receive immunizations to help prevent infections such as pneumonia. This helps to replace the lost function of this organ.[en.wikipedia.org]

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