Abstract
The spleen is one of the most frequently affected organs in blunt abdominal trauma. Since Upadhyaya, the treatment of splenic trauma has undergone important changes. Currently, the consensus is that every splenic trauma presenting with hemodynamic stability should be initially treated nonoperatively, provided that the hospital has adequate structure and the patient does not present other conditions that indicate abdominal exploration. However, several topics regarding the nonoperative management (NOM) of splenic trauma are still controversial. Splenic angioembolization is a very useful tool for NOM, but there is no consensus on its precise indications. There is no definition in the literature as to how NOM should be conducted, neither about the periodicity of hematimetric control, the transfusion threshold that defines NOM failure, when to start venous thromboembolism prophylaxis, the need for control imaging, the duration of bed rest, and when it is safe to discharge the patient. The aim of this review is to make a critical analysis of the most recent literature on this topic, exposing the state of the art in the NOM of splenic trauma.
Highlights
The spleen is one of the most frequently affected organs in abdominal trauma[1,2], presenting injuries in up to 16% to 23.8% of polytraumatized patients, with a mortality rate of 9.3%, mainly due to associated injuries and delayed treatment[3,4]
Splenic lesions are most often classified according to the American Association for the Surgery of Trauma (AAST) Organ Injury Scale[12]
These include the frequency of clinical reevaluations and laboratory tests, the duration of patient monitoring, transfusion thresholds that would indicate intervention, time to iniciate venous thromboembolism (VTE) prophylaxis, the time of bed rest and hospital stay, the need for immunization after spleen embolization and after extensive splenic injury submitted to nonoperative management (NOM), the indication of control imaging and outpatient follow-up after hospital discharge[5,7,18]
Summary
Non-operative management of blunt splenic trauma: evolution, results and controversies. José Donizeti Meira Júnior[1 ]; Carlos Augusto Metidieri Menegozzo, TCBC-SP1; Marcelo Cristiano Rocha, TCBC-SP1; Edivaldo Massazo Utiyama, TCBC-SP1
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