Iatrogenic Splenic Injury Research Articles

Splenic Salvage Following Iatrogenic Splenic Artery Injury Post-gastrectomy

Splenic Salvage Following Iatrogenic Splenic Artery Injury Post-gastrectomy

Predictors of iatrogenic splenic injury in radical gastrectomy for gastric cancer.

Iatrogenic splenic injury (ISI) is a recognized complication in radical gastrectomy that may result in incidental splenectomy (IS). However, the predictors of such events remain largely unknown. Medical records of the patients who underwent radical gastrectomy at our institution between January 2015 and December 2022 were retrospectively reviewed. Potential predictors of ISI and IS were collected and analyzed by multivariate logistic regression. Results were reported as an odds ratio (OR) with 95% confidence intervals (CI). A total of 2916 patients were included, of whom 211 patients (7.2%) suffered from ISI and 75 patients (2.6%) underwent IS. Multivariate analysis demonstrated that BMI≥25 (OR: 3.198 (2.356-4.326), p<0.001), total gastrectomy (OR: 2.201 (1.601-3.025), p<0.001), and the existence of "criminal fold" (OR: 13.899 (2.824-251.597), p=0.011) were independent predictive risk factors for ISI; whereas laparoscopic surgical approach (OR: 0.048 (0.007-0.172), p<0.001) was a protective factor for ISI. Moreover, the existence of "criminal fold" (OR: 15.745 (3.106-288.470), p=0.008) and BMI≥25 (OR: 2.498 (1.002-6.046), p=0.044) were identified as independent risk factors of ISI under laparoscopic gastrectomy. There was no association between sex, age, previous abdominal surgery, neoadjuvant therapy, outlet obstruction, tumor stage, nodal stage, and total lymph node retrieved and ISI. BMI≥25 and total gastrectomy can predict high risk of ISI during radical gastrectomy. Laparoscopic surgery is superior to open gastrectomy in lowing the risk of ISI.

Moderate Splenic Injury Caused by Colonoscopy.

Little is known about iatrogenic splenic injury (SI) as an adverse event after colonoscopy. SI is sometimes fatal because of hemorrhaging. We herein report a man who developed SI after colonoscopy. He recovered conservatively. His history of left hydronephrosis and insertion with a maximally stiffened scope were suspected as possible risk factors. Endoscopists should consider the possibility of SI when they encounter patients suffering from left-sided abdominal pain after colonoscopy. Careful interview concerning the medical history and gentle maneuvering around the splenic flexure can help avoid SI.

THE PREDICTORS OF MORTALITY IN NON-TRAUMATIC SPLENECTOMIES.

There are quite a few studies examining prognostic factors in non-traumatic splenectomies compared to traumatic ones. This study aimed to evaluate the predictors of mortality in patients who underwent splenectomy for non-traumatic spleen diseases. Medical records of the patients, who had undergone total splenectomy for non-traumatic spleen diseases at a tertiary center between January 2009 and December 2019, were retrospectively reviewed. Exclusion criteria included patients younger than 18 years of age, partial splenectomies, splenectomies applied to facilitate surgery for malignancy on contiguous organs, and splenectomies performed during liver transplantation. Iatrogenic splenic injuries were regarded as trauma and these cases were also excluded. The current study included 98 patients. Nine (9.2%) patients died. In univariate analysis, age, the presence of hematological neoplasia, hematocrit, hemoglobin, white blood cell counts, neutrophil-to-lymphocyte ratio, indications for splenectomy, application of emergency surgery, surgical technique, and transfusion of blood components were all significantly associated with mortality. In multivariate analysis, the presence of hematological malignancy [P=0.072; OR=7.17; (CI: 0.386-61.56)], the application of emergency surgery [P=0.035; OR=8.33; (CI: 1.165-59.595)] and leukocytosis [P=0.057; OR=1.136; (CI: 0.996-1.296)] were found to be positively associated with mortality. Hematologic neoplasia, emergency surgery, and leukocytosis were the independent predictors of mortality in patients, who were operated on for non-traumatic spleen diseases. A thorough preoperative evaluation, early therapeutic intervention, and advanced surgical techniques are important and can serve to minimize complications and mortality in case of inevitable splenectomy. Immunological research can provide new therapeutic opportunities that may impact positively on patients by minimizing morbidity and mortality.

Intermittent Splenic Artery Occlusion Plus Gauze Compression Is a Simple and Effective Treatment for Iatrogenic Splenic Injury

BackgroundThe aim of this study was to evaluate the feasibility and safety of intermittent splenic artery occlusion plus gauze compression in treating iatrogenic splenic injury.Material/MethodsWe retrospectively analyzed 12 iatrogenic splenic injury cases (grade I to III) treated with intermittent splenic artery occlusion plus gauze compression. The hemostatic effect was then observed after unblocking and decompression. The total operation time, gauze compression time, total blood loss, blood loss from the injured spleen, and platelet counts of each patient before and 1 week after surgery were noted.ResultsThe average operation time was 209.58±57.11 min, and the average gauze compression time after spleen artery occlusion was 23.75±4.33 min. The average total blood loss and blood loss due to iatrogenic spleen injury were 468.33±138.22 ml and 264.17±165.72 ml, respectively. Two cases (both grade I) had successful hemostasis after 15 min of splenic artery occlusion and wound compression. Another 9 cases (all grade II) and 1 case (grade III) attained hemostasis after 25 min and 30 min, respectively, of splenic artery occlusion and wound compression. The platelet counts of all patients were within the normal range before and 1 week after surgery. No postoperative complications occurred.ConclusionsIntermittent splenic artery occlusion plus gauze compression is a simple and effective treatment for iatrogenic splenic injury.

A218 - The application of intermittent splenic artery occlusion in iatrogenic splenic injury-A case of LSG

Objectives: To evaluate the feasibility and safety of intermittent splenic artery occlusion in iatrogenic splenic injury.

Iatrogenic splenic injury following colonoscopy: Case example and review of current literature

Iatrogenic splenic injury following colonoscopy: Case example and review of current literature

Iatrogenic splenic injury following colonoscopy: Case example

Iatrogenic splenic injury following colonoscopy: Case example

Iatrogenic spleen injury risk during robotic left colonic and rectal resections by routine left flexure mobilization technique: a retrospective study.

The routine mobilization of the left colonic flexure as a standard procedure during left colonic/rectal resection is a controversial topic in open and minimally invasive surgery. According to some authors, this maneuver may increase the risk of iatrogenic spleen damage; for others this does not change the odds. Ligaments over-traction is the most frequent injury mechanism. Some documented risk factors are reported: laparotomic approach, male gender, vascular disease, cancer, diverticulitis, surgery performed in emergency-setting. The type of procedure influences the associated risk: transverse colectomy is the riskiest, followed by left colonic resection and pancolectomy. Retrospective original paper. Sample size - a total of 125 patients have been considered. 75 robotic left colonic resections (60%), 40 robotic rectal resections (32%) and 10 robotic pancolectomy (8%). Primary outcomes - 1) percentage of iatrogenic splenic injuries; 2) conversion rate. Secondary outcomes - 1) intra-/postoperative complications; 2) anastomotic leakage rate; 3) mortality. In order to avoid potential confounding factors and technical/expertise heterogeneity, all the procedures included have been performed using the same standardized operative technique and by the same experienced surgeon (P.C.G.). We retrospectively analyzed 125 procedures. Primary outcomes - 1) iatrogenic splenic injuries: 0%; 2) conversion rate: 1.6%. Secondary outcomes - 1) intraoperative complications: 0%; 2) anastomotic leakage rate: 1 case of leakage out of 125 cases (1.3% of the left colectomy sub-sample); in this case the leakage was probably due to an infectious process rather than a vascular deficit; 3) mortality: 0%; 4) miscellanea postoperatory complications (small bowel obstructions, wound infection, pelvic collections, pneumonia and acute kidney injury) are detailed in the manuscript. In our experience, and according to some of the literature data as well, during robotic left colonic/rectal resections the routine mobilization of the left flexure as a standard procedure is not a risk factor in terms of iatrogenic spleen injury rate. Conversely, this technique may be beneficial as it does not excessively extend the operative time, increases the surgical skills acquirement, and reduces the tension-related anastomotic ischemia. It also allows a better oncological dissection. Standard laparoscopic approach reduces the rate of spleen by almost 3.5 times in comparison to open surgery. The improved technical accuracy provided by the robotic platform may decrease the rate of splenic injury. More studies are needed on the topic to confirm our findings.

Iatrogenic spleen injury during minimally invasive left colonic flexure mobilization: the quest for evidence-based results.

To assess the frequency, risk factors and outcomes of iatrogenic spleen injury during minimally invasive colo-rectal surgery with a particular focus on the routine splenic flexure mobilization tehcnique. Exclusion criteria: 1) topic not pertinent to the main topic of the review; 2) all case reports, editorials, conference highlights were excluded. After a title and abstract first selection and a final full-text analysis has been performed. The results of the selected articles are presented. The iatrogenic splenic injury rate during colorectal surgery is 0.96%. The iatrogenic injuries cause around 20% of all splenectomy. Ligaments over-traction is the most frequent mechanism of damage. The routine splenic flexure mobilization is a matter of scientific debate. Risk factors - open surgery, male sex, peripheral vascular disease, malignant neoplasia, diverticulitis, emergency surgery and teaching-hospital status. There is a risk difference according to the procedure: transverse colectomy has the highest risk, followed by left colectomy and total colectomy. The routine mobilization of the left colonic flexure is a debated topic. However, according to some authors (including our experience), this procedure is not a risk factor and it may be advantageous: 1) it does not excessively prolong the total operative time; 2) better surgical skills development; 3) the tension-related ischemia is avoided; 4) wider oncological dissection. Technical accuracy with cautious dissection/visualization can reduce the rate of iatrogenic splenic damage. Laparoscopy decreases the rate of splenic injury by almost 3.5 times. Robotic surgery may have the potential to further reduce this complication, but more data are needed on the topic.

Splenectomy indications and postoperative follow-up results of a department of general surgery

Aim: Splenectomy is commonly performed in many centers around the world for the treatment of various benign, malign diseases and trauma nowadays. The purpose of this study is to determine the indications in patients undergoing splenectomy in a general surgery department for five years and to investigate the mortality rate and reasons. Material and Methods: Data of the study were obtained retrospectively by scanning records of patients over the age of 18 who underwent open splenectomy in the general surgery department between December2012 and December2017. Demographic data, duration of hospitalization, distribution of emergency and elective operations, main reasons and indications of splenectomy, operation components, histopathological results, the survey of patients and mortality rate were investigated. Results: 55,4% (n=31) female, 44,6% male, total 56 patients were included in the study. The mean age of the patients was 50.5±22,6. The mean duration of hospitalization was 9±7 days. 71.4%of the patients were operated under elective conditions and 28.6%of the patients were operated under urgent conditions. Splenectomy was done for the reason of carcinoma in 34.2% of patients, traumatic splenic injury in 19.4%, splenic cyst or abscess in 16.2%, coagulopathy in 12.6%, iatrogenic splenic injury in 5.4%, lymphoma in 3.6%, splenomegaly associated with portal hypertension in 3.6%, fibrosarcoma in 1.8%, idiopathic splenomegaly in 1.8%. Conclusion: Splenectomy is performed in general surgery departments due to traumatic and non-traumatic indications. Mortality due to pure splenic pathologies is uncommon and quite rare. However, mortality caused by other operations and diseases in patients who underwent splenectomy is quite high.

Splenic Injury after Screening Colonoscopy; Could that Happen Twice? An Unusual Case Report

Iatrogenic splenic injury is a known but rare complication of colonoscopic procedures. Our department describes a very interesting case of the same complication that occurred twice on the same patient.

How to reduce splenic injury in laparoscopic radical gastrectomy: Criminal ligament priority separating.

e15528 Background: Iatrogenic splenic injury may lead to conversion or nontherapeutic splenectomy in laparoscopic gastrectomy. A critical point at splenic injury occurs is improper traction of spleen-omentum ligament which was called crimimal ligament (CL). We aimed to explore the efficacy of cirminal ligament priority separating (CLPS) to reduce iatrogenic splenic injury in laparoscopic radical gastrectomy. Methods: Complete videos of 540 laparoscopic radical gastrectomy in Guangdong Provincial Hospital of Chinese Medicine were reviewed. The relationship between CLPS and iatrogenic splenic injury was determined. CL was defined as the ligament between omentum and spleen. CLPS was defined as that CL was firstly separated when mobilization was in left upper quadrant. Results: CL was present in 81.5% (440/540) and were included for analysis. There was variation in the distribution pattern of CL and it mostly appeared in the lower pole of spleen (414/440). CLPS was performed in 24.5% (108/440) and 75.5% (332/440) were not (un-CLPS). In systematic review, the incidence of iatrogenic splenic injury was 10.9% (48/440). Among these patients, 79.1% (38/48) were due to improper traction of CL and they were all in un-CLPS group. Instrument injury was occurred in 2.2% (10/440) and 3 were in CLPS group and 7 were in un-CLPS group. Most iatrogenic splenic injury were successfully handled with electrocoagulation, adhesive and compression technique, except 2 patients underwent conversion to open splenectomy for serious splenic injury in un-CLPS group. Conclusions: In laparoscopic surgery for gastric cancer, iatrogenic splenic injury mostly resulted from improper traction of CL and CLPS could reduce the incidence of iatrogenic splenic injury.

The application of intermittent splenic artery occlusion for treating iatrogenic splenic injury: an animal experiment

Objective To evaluate the value of intermittent splenic artery occlusion in the treatment of iatrogenic splenic injury and the cause of ischemia reperfusion injury. Methods Experimental animals using dogs were divided into experimental group and control group according to whether the splenic artery was blocked. The animal model of iatrogenic splenic injury was established by general anesthesia. Experimental group was treated with intermittent splenic artery blockage combined with gelatin sponge oppression of the wound to stop bleeding. The first time of splenic artery occlusion was 15 min and continued for 10 min and for another 5 min if still bleeding. Then hemostatic effect after removing blocking and oppression was observed. Control group was only treated with gelatin sponge compression to stop bleeding. Blood samples and tissue samples were collected before blocking and after reperfusion for 2 hours in experimental group, and before compression and relieving the compression for 2 hours in control group. IL-1 (interleukin), SOD (superoxide disproportionation enzyme), MPO (myeloperoxidase), MDA (malondialdehyde) and caspase-3 (aspartame acid cysteine protease) were detected. Results The control group still had bleeding, while the experimental group had successfully stopped bleeding. Serum markers before and after occlusion in the experimental group were IL-1 (124.4±106.8 vs.121.2±105.1), SOD (4.7±2.7 vs.5.2±1.8) and MDA (8.8±6.5 vs10.8±7.5). There were no significant differences on serum markers in two groups after occlusion/oppression including IL-1 (121.2±105.1 vs. 162.8±73.8), SOD (5.2±1.8 vs. 4.7±2.8) and MDA (10.8±7.5 vs. 9.6±6.6) (P>0.05). Histological indicators before and after occlusion in the experimental group included MPO (0.62±0.23 vs. 0.68±0.21) and Caspase-3 (0.90±0.29 vs. 0.86±0.26), and there was no statistical difference on MPO (0.68±0.21 vs. 0.86±0.23 after two sets of experiments) and Caspase-3 level (0.86±0.26 vs.1.21±0.18) (P>0.05) in two groups after occlusion/oppression. Conclusion The therapeutic effect of intermittent splenic artery occlusion combined with gelatin sponge compression hemostasis is safe and effective and without obvious ischemia reperfusion injury. Key words: Iatrogenic splenic injury; Intermittent splenic artery occlusion; Animal experiment; Canine; Gelatin sponge

Emergency abdominal surgery in patients with left ventricular assist device: short- and long-term results.

IntroductionEmergency abdominal surgery (EAS) in patients with long-term mechanical circulatory support and strong anticoagulation is very difficult.AimTo present our experiences regarding the short- and long-term results of patients with a left ventricular assist device (LVAD) who underwent emergency abdominal surgery under general anesthesia at a large tertiary healthcare center.Material and methodsThe electronic medical records of 7 patients with LVAD who underwent EAS between January 1, 2010 and December 31, 2016 were retrospectively investigated in order to evaluate perioperative management and outcomes. The patients were divided into two groups based on the need for EAS procedures.ResultsSeven (9.2%) of 76 patients with LVAD underwent EAS an average of 79.1 ±79.4 days after implantation. No statistically significant differences were found between the groups with and without EAS with regard to demographic characteristics, type of device, and rate of perioperative mortality (p > 0.05). The indications for surgery, retroperitoneal hematoma in 2 patients and in 5 other patients; ileus, iatrogenic splenic injury associated with thoracentesis, splenic abscess, acute abdominal pain and rectal cancer surgery was a pelvic abscess in a patient who is connected to the stump. In all cases laparotomy was performed with median incision. The perioperative mortality rate was 28.6% (n = 2). Two patients underwent orthotopic heart transplant during long-term follow-up.ConclusionsThe EAS is not rare during LVAD treatment but is a rather complex procedure. General surgeons will be increasingly likely to encounter such patients as their numbers rise and their life expectancies are prolonged.

Iatrogenic splenic injury after thoracentesis in a patient with a ventricular assist device system

Iatrogenic splenic injury after thoracentesis in a patient with a ventricular assist device system

Iatrogenic splenic injury: review of the literature and medico-legal issues.

Introduction: Iatrogenic splenic injury is a recognized complication in abdominal surgery. The aim of this paper is to understand the medico-legal issues of iatrogenic splenic injuries. We performed a literature review on PubMed and Scopus using iatrogenic splenic or spleen injury and iatrogenic splenic rupture as keywords. Iatrogenic splenic injury cases were identified. Most cases were related to colonoscopy, but we also identified cases related to upper gastrointestinal procedures, colonic surgery, ERCP, left nephrectomy and/or adrenalectomy, percutaneous nephrolithotomy, vascular operations involving the abdominal aorta, gynecological operation, left lung biopsy, chest drain, very rarely spinal surgery and even cardiopulmonary resuscitation. There are several surgical procedures that can lead to a splenic injury. However, from a medico-legal point of view, it is important to assess whether the cause can be attributed to a technical error of the operator rather than being an unpredictable and unpreventable complication. It is important for the medico-legal expert to have great knowledge on iatrogenic splenic injuries because it is important to evaluate every step of the first procedure performed, how a splenic injury is produced, and whether the correct treatment for the splenic injury was administered in a judgment.

A solution to the negative effects of splenectomy during colorectal trauma and surgery: an experimental study on splenic autotransplantation to the groin area.

BackgroundSplenectomy after combined colosplenic trauma or iatrogenic splenic injury during colorectal surgery associates with worse short- and long-term outcomes, including reduced survival in patients with colorectal cancer. Splenic autotransplantation may improve the outcomes of such patients. Omental splenic transplantation is the standard procedure but may be difficult when performing laparoscopic colorectal surgery or when total or subtotal omentectomy is required. This animal model study was performed to evaluate the impact of splenic autotransplantation to the groin area on colonic wound healing.MethodsThirty rats were divided into three groups of ten animals. One group underwent colon anastomosis and sham splenectomy, the second underwent colon anastomosis and splenectomy, and the third underwent colon anastomosis, splenectomy, and intramuscular autotransplantation of the spleen. On postoperative day 7, anastomotic healing was evaluated by measuring bursting pressure and hydroxyproline levels. The third group was subjected to scintigraphy before sacrifice to assess whether the transplant was functional.ResultsThe mortality rates of the sham, splenectomized, and transplanted animals were 0 %, 30 %, and 20 %, respectively: the splenectomized animals had significantly lower mean bursting pressures than the other two groups (p = 0.002). The mean hydroxyproline levels of the three groups were 467.4, 335.3, and 412.7 mg hydroxyproline/g protein, respectively (p = 0.0856). Nine of the ten transplanted animals (90 %) had splenic activity on scintigraphy.ConclusionsSplenectomy impaired the healing of the colonic anastomosis. This effect was largely reversed by splenic autotransplantation. Intramuscular autotransplantation to the groin area appears to be feasible and effective.

Nonsurgical management of multiple splenic abscesses in an obese patient that underwent laparoscopic sleeve gastrectomy: case report and review of literature

Key Clinical MessageSleeve gastrectomy (SG) is a surgical weight-loss procedure. Splenic abscess is a rare complication of SG. Four cases of splenic abscess after SG have been reported, all managed by surgical intervention. We report the first documented case of multiple splenic abscesses following SG managed conservatively by an integrated medical treatment.

Experience with sliding-clip splenorrhaphy for splenic injury during radical nephrectomy.

We report our experience with sliding-clip splenorrhaphy (SCS), a novel splenic conservation technique, for iatrogenic splenic injury (ISI) during a left radical nephrectomy (RN). We also reviewed the literature on ISI. We retrospectively reviewed data from patients who had RN between January 2005 and December 2013 at our institution. The technique used was similar to sliding-clip renorrhaphy. Our Medline literature identified articles containing "splenic injury during nephrectomy," "iatrogenic splenic injury." "iatrogenic splenectomy," and "splenorrhaphy." Our primary outcome measures included incidence of splenic injury and splenic conservation rate and splenectomy. Among the 370 RN, 140 were left sided. ISI injury occurred in 6 left RN (incidence 1.6% for all nephrectomies, 4.2% for left-sided nephrectomies). All 6 cases had open procedure and for the left-sided procedure. Splenic conservation was attempted in 4 patients using SCS and 3 out of 4 were successfully repaired. Altogether 3 patients had splenectomy (incidence 0.8% for all nephrectomies, 2.1% for left-sided nephrectomies). Our literature review revealed that the incidence of iatrogenic splenectomy during left nephrectomy varies from 1.3% to 13.2%. SCS is an acceptable novel splenic conservation technique due to its ease of use and success in selected patients with ISI. There is little evidence on the true incidence of ISI especially on splenic conservation during nephrectomy. Every attempt at splenic conservation is likely to improve immediate- and long-term patient outcomes.