Minor Lacerations Research Articles

How little is enough? The feasibility of conducting a dose-escalation study for exercise training in people with stroke

QuestionIs it feasible and safe to conduct an exercise dose-finding study in people with stroke? Is it possible to determine a minimal dose of exercise required to see clinically meaningful improvements in cardiorespiratory fitness? MethodsDose-escalation study. Twenty people with stroke (n=5 per cohort) who were able to walk independently participated in home-based, telehealth-supervised aerobic exercise sessions 3 d/week at moderate-vigorous intensity for 8 weeks. Dose parameters of frequency (3 d/week), intensity (55-85% of heart rate peak) and program length (8 weeks) were kept constant. The duration of exercise sessions was increased by 5 min per session from Dose 1 (10 min/session) to Dose 4 (25 min/session). Doses were escalated if safe and tolerable (< 33% of a cohort reaching a dose-limiting threshold). Doses were efficacious if ≥ 67% of a cohort increased peak oxygen consumption ≥ 2mL/kg/min. ResultsTarget exercise doses were well adhered to, and the intervention was safe (480 exercise sessions delivered; one fall resulting in minor laceration) and tolerable (no participants met the dose-limiting threshold). None of the exercise doses met our criterion for efficacy. ConclusionsIt is possible to conduct a dose-escalation trial for people with stroke. The small cohort sizes may have limited the ability to determine an efficacious minimum dose of exercise. Providing supervised exercise session at these prescribed doses via telehealth was safe. RegistrationThe study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000460303).

A RARE CASE OF MOREL LAVELLEE LESION

Introduction: Morel-Lavallée lesions are post-traumatic, closed degloving injuries occurring deep to subcutaneous plane due to disruption of capillaries resulting in an effusion containing hemo-lymph and necrotic fat. It is an uncommon condition that results from a shearing force, causing a gloving injury which may get infected and lead to a life-threatening situation. Case Presentation: A 28 year old female patient presented to the emergency department with a history to Road trafc accident and sustained minor lacerations to the left lower limb and a contusion over the lateral aspect of the left thigh. The patient was found to have MLL upon ultrasound over the contused area, which was then incised and drained. The wound healed well over 3 weeks and split skin grafting was done which was successfully taken up. MLL's are rare forms of closed degloving Discussion: injuries which may be missed upon initial examination and mis-diagnosed as a contusion. If not treated promptly, it may lead to infection of the collected blood and overwhelming sepsis. It is important for clinicians to be Conclusion: aware of Morel Lavellee lesions as the diagnosis is more reliable on clinical examination and prompt diagnosis may prevent life-threatening complications in trauma patients

Biological control of fall webworm larva (Hyphantria cunea Drury) and growth promotion of poplar seedlings (Populus × canadensis Moench) with Bacillus licheniformis PR2

The production of Populus × canadensis Moench seedling, as an important restoration resource has been constrained by the invasion of Hyphantria cunea Drury, a polyphagous pest that causes leaf feeding damage on nursery seedling production. This study investigated the larvicidal potential of cuticle degrading chitinase and protease enzymes secreted by the Bacillus licheniformis PR2 against H. cunea larvae. In addition, we investigated the growth promotion of P. canadensis seedling through the auxin belonging to plant growth hormones. Treatment of H. cunea larvae with either the bacterial crude enzymes or bacterial culture broth from B. licheniformis PR2 under laboratory conditions resulted in larvae mortality due to the severe degradation of the cuticle characterized by the loss of setae, swelling of sockets, and rupturing of the epicuticle and procuticle, and also caused a repellent effect from leaves, when the larvae suffered minor lacerations only in the epicuticle except the procuticle. Application of B. licheniformis PR2 culture broth on P. canadensis seedlings in the greenhouse experiment caused a mortality rate of 34.4 % and a repellency rate of 75.0 % against H. cunea larvae and reduced the leaf damage rate by 3.7-folds to only 25.9 % compared to 96.3 % in the control group. Accordingly, treatment with B. licheniformis PR2 improved seedling growth by reducing foliar damage caused by H. cunea larvae. In addition, B. licheniformis PR2 produced indole-3-acetic acid (IAA), which improves root hair growth and lateral root development to increase the surface area for nutrient uptake. Thus, inoculation of B. licheniformis PR2 improved the leaf chlorophyll content (photosynthetic rate) of the P. canadensis seedlings by 1.9-folds to 43.26 units compared to 23.26 units in the control group. Consequently, the application of B. licheniformis PR2 also improved the shoot, root, and leaf dry weights by 3.4-, 1.5- and 1.6-folds compared to the control group, respectively. Therefore, this study demonstrates the dual larvicidal and plant growth-promoting potential of B. licheniformis PR2, as an environmentally friendly alternative to chemical pesticides in the control of H. cunea larvae and production of healthy P. canadensis seedlings in the forest nursery.

Efficacy of ground‐based trapping of coastal American black bears in Prince William Sound, Alaska

AbstractGround‐based trapping can be the most practical approach for capturing American black bears (Ursus americanus) in remote portions of Alaska. During the summers of 2016–2018 we captured 106 black bears in a coastal portion of southcentral Alaska, USA, using bucket cable traps and Aldrich snare sets, 2 common foot snaring techniques. Despite widespread use, little research has focused on factors contributing to success and differences in safety for both foot snaring techniques. We compared trap engagement and success and found that bears engaged with bucket cable traps at a 31% (CL = 3–50%) lower rate than with Aldrich snare sets but once engaged were equally likely to be successfully snared. Prebaiting sites increased capture success 362% (CL = 21–1663%) but it was unclear if success improved when sites were prebaited multiple times. Regardless of trap type, bear engagement with sets were 194% higher (CL = 94–345%) during mid‐day hours (0800–1559) compared to crepuscular or nocturnal hours. We observed average injury scores of less than 11 points (out of 400 possible points) for both set types, consistent with the score given for minor lacerations. Both methods performed well within the recommended safety standards of the American Society of Mammalogists.

Anterior Longitudinal Ligament Flap Technique: Description of Anterior Longitudinal Ligament Opening During Anterior Lumbar Spine Surgery and Review of Vascular Complications in 189 Patients

One of the main concerns of anterior lumbar spine approaches are vascular complications. The aim of our study is to provide technical details about a flap technique using the anterior longitudinal ligament (ALL) when approaching the lumbar spine via an anterior corridor. This can help decrease complications by protecting the adjacent vascular structures. We also include a retrospective cohort review. This is a retrospective bicentric study: 189 patients with a mean age of 44.2 years underwent anterior lumbar spine surgery using the ALL flap technique. Patients were diagnosed with degenerative pathologies. We treated 239 lumbar levels primarily at the L4-5 and L5-S1: 88 single-level anterior lumbar interbody fusions, 9 two-level ALIFs, 51 total disk replacements (TDR), and 41 hybrid constructs (i.e., ALIF L5S1 and TDR L4L5). Anterior approaches were performed by two senior spine surgeons. The ALL flap technique was utilized in all of these cases, by carefully dissecting the ALL, with the flap suspended using sutures. As such, this ALL flap provided a "safe corridor" to avoid any potential vascular laceration. The operative and early surgical complication rate was 3.2%. There was no arterial injury. There were only 2 minor venous lacerations (1.05%). No blood transfusion was required. Neither lacerations happened during disk space preparation. Here, we provide technical details about a simple and reproducible technique using the ALL as a flap, which may help spine surgeons minimize vascular injuries during ALIF or even TDR surgeries.

Making a meal out of bugs

Making a meal out of bugs

Association of intravenous antispasmodics (hyoscine-N butyl bromide) injection with obstetric lacerations at vaginal delivery

Aim: To study whether hyoscine-N butyl bromide injection affects the incidence of obstetric lacerations at vaginal birth.&#x0D; Materials and methods: This retrospective cohort study consists of 15806 term pregnant women who undergone vaginal delivery, in Tepecik Training and Research Hospital, İzmir between January 2018 and December 2020. Patients who received intravenous injection of Hyoscine-N-butylbromide during the active period of labor were compared with those who did not in terms of the incidence of obstetric laceration.&#x0D; Results: The data of a total of 9216 deliveries meeting the study criteria were analyzed. Hyoscine-N-butylbromide was used in 4014 of these deliveries(HBD), and it was not used in 5202 of these deliveries. In both primigravid and multigravid patients in the HBD group, the first stage of delivery was found to be shorter than in patients who did not receive spasmolytics(p &lt;0.001).There was no difference between the groups in terms of the second stage of labor. Intravenous injection of Hyoscine-N-butylbromide in the active phase of labor significantly reduced 1st and 2nd degree obstetric lacerations in primigravid patients, but had no effect on 3rd and 4th degree obstetric lacerations.&#x0D; Conclusion: Hyoscine-N-Butylbromide shortens the active phase of labor and reduces minor obstetric lacerations in primigravid women.

Acquired Rectovaginal Fistula and Faecal Incontinence Following Sexual Assault in a 4-Year-Old Girl

Background: Child Sexual Abuse (CSA) is a crime against children. It is largely under-reported and commonly goes unpunished in our society.&#x0D; Case report: The patient is a 4-year-old girl who presented to our emergency paediatric unit with 14 hours duration of faecal incontinence following sexual assault by her landlord’s son. She also complains of pelvic pain and difficulty in walking. The landlords’s son forced his penis into her anus and inserted his fingers through her vagina.&#x0D; On examination of her anal region, there was anal sphincter tear at six 0’ clock, extending exteriorly to the right measuring 1 cm long and 0.5 cm deep with a rectovaginal fistula. Vaginal examination revealed minor laceration and excoriation on the right lateral wall and floor of the vagina, with mild bleeding. She had a left hymenal tear at the lower aspect and a vagina floor tear. Results of urine microscopy culture and sensitivity (MCS) revealed white blood counts (WBC) 2+, leucocytes 2+, epithelial cells+, Staphylococcus aureus was isolated which was sensityive to amoxiciilin.&#x0D; The child was resuscitated and given antibiotics and analgesics and prophylactic antiretroviral drugs. She had a perineal tear repair by the paediatric surgeon. She was placed on sitz bath and she responded well with good healing and recovery. She was discharged after 2 weeks on admission and came back for follow-up.&#x0D; This report highlights the management of a case of rectovaginal fistula in a child as a result of sexual assault.

Ultrasound-Guided Percutaneous A1 Pulley Release by Acupotomy (Needle-Knife): A Cadaveric Study of Safety and Efficacy.

PurposeThis study was to assess the safety and effectiveness of ultrasound-guided percutaneous A1 pulley release by acupotomy on unembalmed cadavers.Materials and MethodsSixty digits (from six cadavers, three male and three female) were split into two groups using stratified randomization. All procedures were completed by a single doctor with rich experience in ultrasound-guided treatment. In the acupotomy group, the A1 pulley was released under ultrasound-guided by a needle-knife; while in the needle group, the A1 pulley was released under ultrasound-guided by a 21-gauge needle. Two groups completed six thumbs and 24 fingers, respectively. Another anatomist, blinded to the two techniques, assessed the safety, including the minimum distance between the incision and the neurovascular; flexor tendon, neurovascular and A2 pulley injury or not. Completeness release of the A1 pulley was recorded as effectiveness.ResultsNo neurovascular or A2 pulley injuries were recorded. However, the incision of the thumb in both groups biased to the radial side (P <0.05), while the incision of the finger biased to the ulnar side (P <0.05). No significant flexor tendon injury was found, and only five cases (16.7%) had minor scratches in the acupotomy group; while in the needle group, 15 cases had minor scratches and lacerations occurred in three cases. The flexor tendon injury rate was 60%. Compared with the needle, ultrasound-guided acupotomy release is safer (P <0.05). The ultrasound-guided acupotomy technique was significantly more likely to result in a complete A1 pulley release compared to the needle technique (28 of 30 [93.3%] versus 11 of 30 [36.7%]; P <0.05).ConclusionUltrasound-guided percutaneous A1 pulley release by acupotomy is a safe and effective technique. When releasing the thumb by ultrasound-guided, be careful not to bias to the radial side to avoid neurovascular injury, while when releasing a finger, be careful not to bias to the ulnar side.

Clinical Presentations, Physician Consultations and Patient Transport Options for Australian Remote and Industrial Paramedics

Introduction The aim of this study was to provide a snapshot of Australian remote and industrial paramedics’ patient clinical presentations, experience with physician consultations and options for patient transport to tertiary care. Methods This exploratory, cross-sectional descriptive study employed a purpose-built online survey. Participants were 78 paramedics working in Australian rural and remote industrial settings recruited in 2015 using web-based, respondent-driven sampling. In addition to a series of closed ended questions, respondents were asked to recall the number of times they encountered specific clinical presentations during the past year. Data were analysed using descriptive statistics and modes were calculated for ordinal data associated with clinical presentations. Results The traumatic presentations that participants recalled encountering at least 10 times the preceding year included back pain (39.7%), minor lacerations (38.5%), joint (36.4%) and hand (30.8%) injuries. Respondents selected headache (64.1%), nausea, vomiting or diarrhoea (52.6%), respiratory infections (50%), ear, nose or throat problems (43.6%) and localised infections or rash (39.7%) as the most common medical presentations. Of the respondents, 38.4% managed patients with mental health presentations a minimum of six times in the preceding year, and 45.3% treated at least one patient in cardiac arrest. While 94.8% of participants said topside support was available, over half described consulting physicians infrequently and if they did, it was typically by telephone. Most respondents (61%) indicated that their worksite was located over 100 km from a hospital. Conclusion Survey findings indicate that paramedic participants recall encountering a wide range of clinical presentations and managing low acuity illnesses more commonly than traumatic injuries. Most respondents were located at least 100 km from the nearest hospital and although almost all had access to topside support, over half stated they consulted physicians infrequently.

Traumatic Bull Gore Injuries to Oropharynx- A Case Report

Bull gore injury is not an uncommon injury comprises 2% among the traumatic injuries, especially in the rural area. The damage is predominantly caused by the animal's horn tip. The abdomen and perineum are the most commonly affected organs; additional organs include the lower limb, upper limb, chest, and others. Palatal lacerations are more common in children when they put objects in their mouth or by falling down with the object inside, but oropharyngeal injuries due to bull gore are scarce. Authors hereby reports two cases, in first case, a 3-year-old female child was brought with alleged history of injury to the soft palate by the horn of a cow. The tensor veli palatine muscle tear was repaired, submucosa and mucosal layer was sutured. In second case, a 62-year-old male came with alleged history of trauma, hit by a bull while driving two wheeler following which patient had deep laceration in the submental region, laceration in the floor of mouth and ventral surface of tongue. The mylohyoid muscle injury was identified and repaired. The wound was closed in layers from muscle to skin. Thus, bull gore injuries have a wide range of presentation from minor lacerations to life threatening injuries to oral cavity, neck, chest and abdomen. Timely admission and prompt treatment, repair of lacerations under proper sterile environment is important.

Adhesive Taping Shows Better Cosmetic Outcomes Than Tissue Adhesives for Sutured Upper Extremity Incisions: A Single-Blind Prospective Randomized Controlled Trial.

Adhesive taping is commonly used to reinforce wound closure and approximate minor lacerations. Recently, tissue adhesives such as 2-octylcyanoacrylate have gained popularity because of their high tensile strength, bacteriostatic properties, and spontaneous peeling. We sought to evaluate the cosmetic result of upper extremity incisions closed primarily by subcuticular suture, randomizing the application of tissue adhesive vs adhesive taping to different halves of the same surgical incision. Subjects were recruited from patients undergoing common procedures at the senior surgeon's hand surgery clinic. After primary closure, we applied either quarter-inch adhesive tape or tissue adhesive to the proximal and distal aspects of the wounds, based on a preoperative randomization protocol. We assessed the scars at approximately 3 months (range, 2-5 months). Subjects completed a validated scar assessment questionnaire, and a blinded photograph was obtained to allow 2 independent surgeons to assess the scar. Mean age was 63 years (SD, 11.8 years; range, 21-88 years); 56% of patients were women, and 44% were men. Most of the incisions were open carpal tunnel release and thumb carpometacarpal arthroplasty (14 each). Adhesive taping showed a better overall mean score based on evaluation by the hand surgeons, a finding that was statistically significant. The greatest differences were observed between color and size, but no subcategories were significantly different. Patients reported nonstatistical, but slightly better overall cosmetic outcomes with adhesive taping rather than tissue adhesive. Adhesive strips provide a modest but significant improvement in cosmetic outcomes vs more expensive tissue adhesive. Future evaluation of closure methods that evaluate cost, speed of application, suture technique, and dressing will optimize scar appearance. [Orthopedics. 2022;45(1):e42-e46.].

An audit of emergency response to terrorist-related bomb blasts and gunshot injuries

Context: The management of mass casualty events caused by terrorist-related suicide bombings in densely populated areas is often challenging. Aims: This study describes the pattern of injuries, the emergency response following a suicide bombing in Nigeria in 2014 and compares the outcomes to those of other incidents. Settings and Design: A retrospective analysis of cases that presented to a major tertiary care center was done. Methods and Material: Medical records of 50 patients who experienced bomb blast or gunshot wounds during 28th November, 2014 suicide bombing of the Kano Central Mosque were reviewed and 12 eyewitnesses were interviewed. Statistical analysis used: Descriptive analysis of quantitative data was done while major themes were identified from the key informant interviews. Results: Fifty patients were admitted at the acute care center within 4 hours. There was a male predilection (98%), with a median age of 30 years (IQR, interquartile range = 37.5 years). Most injuries were the result of multiple penetrating projectiles (secondary blast injuries), primarily involving blast-energized metallic fragments like screws, nails, bolts, ball bearings, and metal scraps. Eleven patients (22%) had minor lacerations, about a quarter (n = 12; 24%) had severe hemorrhage and were transfused, five (10%) had multi-system involvement, and mortality rate was 8% (n = 4). Interventions were aimed at preserving the lives of those injured. Conclusion: Most of the victims had major injuries which were appropriately managed although the hospital lacked an existing protocol on mass casualty management. Increased awareness, organized field triage mechanisms, and capacity building in health facilities will facilitate prompt emergency response.

Simultaneous VZV and HSV-1 Reactivation after Minor Head Injury.

An 81-year-old patient presented to the emergency department with a dark lesion on his forehead and swelling of his left eye, 3 days after a minor forehead injury and skin laceration. He also showed singular papules on his chin, upper chest, upper arms and back, later evolving into vesicles. Polymerase-chain reaction testing of vesicle content was positive for VZV and HSV-1, confirming a diagnosis of disseminated cutaneous herpes virus infection and concomitant HSV-1 reactivation. Antiviral and antibiotic treatment was initiated for 1 week with an immediate response. This case report highlights the association of head trauma and subsequent reactivation of VZV in patients at risk. Simultaneous reactivation of HSV-1 and VZV is rare in immunocompetent patients.LEARNING POINTSMinor trauma can cause VZV and HSV reactivation.Consider herpes virus reactivation in case of unclear rash; the appearance of vesicles can be delayed for a few days.Screen for immunodeficiency disorders in disseminated herpes virus infection; if non-apparent, close monitoring is recommended.

Paediatric perineal injury following explosive blast: A Case Report

Perineal injury in children is uncommon. Injuries range from minor perineal skin laceration to severe injury to the genitourinary tract, anorectal region and the pelvic bone. The mechanisms of injury are usually attributed to blunt trauma, penetrating injuries like impalement injury, or sexual abuse. Perineal injury resulting from explosive blast in children is rare. The management depends on the time and mode of presentation and examination findings. Early presentation (a few hours after injury) with 1st or 2nd-degree perineal injury may benefit from debridement with primary repair of soft tissues and/or sphincters. Late presentation (days after injury) with 3rd or 4th-degree injury will require diverting colostomy or urinary diversion and wound drainage. This is a report of an unusual case of severe perineal injury in a child following explosive blast sustained while squatting close to packed explosives that got detonated. The perineal injury was initially managed with colostomy and wound drainage. The colostomy was closed after the wound had healed with good faecal continence achieved and without perineal soft tissue or anal sphincteric repair. It is concluded that severe isolated paediatric explosive blast perineal injury is rare but is amenable to surgical care.

Accuracy of obstetric laceration diagnoses in the electronic medical record.

Patient safety data including rates of obstetric anal sphincter injury (OASI) are often derived from hospital discharge codes. With the transition to electronic medical records (EMRs), we hypothesized that electronic provider-entered delivery data would more accurately document obstetric perineal injury than traditional billing/diagnostic codes. We evaluated the accuracy of perineal laceration diagnoses after singleton vaginal deliveries during one calendar year at an American tertiary academic medical center. We reviewed the entire hospital chart to determine the most likely laceration diagnosis and compared that expert review diagnosis (ExpRD) with documentation in the EMR delivery summary (EDS) and ICD-9 diagnostic codes (IDCs). We retrospectively selected 354 total delivery records. OASI complicated 56 of those. 303 records (86%) were coded identically by the EDS and IDCs. Diagnoses from the IDCs and the EDS were mostly correct compared with ExpRD (sensitivity = 96%, specificity = 100%). There was no systematic over- or under-diagnosis of OASI for either the EDS (p = 0.070) or the IDCs (p = 0.447). When considering all laceration types the EDS was correct for 21 (5.9%) lacerations that were incorrect according to the IDCs. Overall, the EDS was more accurate (p < 0.05) owing to errors in IDC minor laceration diagnoses. Electronic medical record delivery summary data and EMR-derived diagnostic codes similarly characterize OASI. The EDS does not improve OASI reporting, but may be more accurate when considering all perineal lacerations. This assumes that providers have correctly identified and categorized the lacerations that they record in the EMR.

Postpartum Opioid Use Following Vaginal Deliveries with No or Minor Obstetric Perineal Lacerations

Background: Recommendations for management of pain following vaginal delivery are not specific and do not differentiate patients based on the degree of perineal trauma. Our objective is to describe patterns of postpartum opioid use in women with no or minor perineal trauma. Methods: This is a retrospective cohort study describing the characteristics of opioid analgesia usage among women with no or minor perineal lacerations at the time of vaginal delivery in a university affiliated regional hospital. Results: For the 6-month study period, 433 patients were eligible for inclusion. Of these, 423 (97.69%) were ordered as needed narcotics during their post-partum hospitalization. Of women with an as needed narcotic prescribed, 285 (65.82%) used at least one dose of narcotics while hospitalized. Significant patient characteristics of women using opioids during their inpatient post-partum course included those who used epidural analgesia during labor (p=0.009) and primiparous patients (p=0.05). Thirty-five of the women included in the study received a prescription for opioid analgesics at the time of discharge (8.08%). Significant findings among these women include increasing maternal age (p=0.007). Non-academic physicians with resident coverage were 3.1 times more likely to prescribe opioids at discharge compared to academic physicians with residents and non-academic physicians without resident coverage. Conclusions: Focusing specifically on women with no or minor perineal lacerations at the time of delivery, our findings indicate that if given the option of opioids analgesia during their hospitalization, many women will request at least one dose of opioid analgesia, but rarely require opioids after discharge.

The World Small Animal Veterinary Association (WSAVA): List of Essential Medicines for Cats and Dogs.

The World Small Animal Veterinary Association (WSAVA): List of Essential Medicines for Cats and Dogs.

Splenic injuries secondary to colonoscopy: Rare but serious complication.

BACKGROUNDColonoscopy is a safe and routine diagnostic and therapeutic procedure for evaluation of large bowel diseases. Most common procedure related complications include bleeding and perforation but rarely a splenic Injury.AIMTo investigate the reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patientsMETHODSA structured search on four databases was done and 45 articles with 68 patients were selected. The reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients were identified and analyzed using SPSS.RESULTSThe mean age of the patients was 62.7 years with 64% females. Twenty two percent had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma, spleen laceration and spleen avulsion. The most common reason for colonoscopy was screening (46%) followed by diagnostic colonoscopy (28%). Eighty seven percent of patients presented with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%), while minor spleen hematomas and lacerations were managed conservatively (38%). Six percent of the patients were managed with proximal splenic artery splenic embolization and 4% were managed with laparoscopic repair. The overall mortality was 10% while 77% had complete recovery. The reason of colonoscopy against presentation specifically, abdominal pain showed no statistical significance P = 0.69. The indication of colonoscopy had no significant impact on incidence of splenic injury (P = 0.89). Majority of the patients (47%) were managed with splenectomy while the rest were managed conservatively (P = 0.04). This association was moderately strong at a cramer’s V test (0.34). The Fisher exact test showed a higher mortality with spleen rupture (P = 0.028).CONCLUSIONSpleen rupture due to colonoscopy is a significant concern and is associated with high mortality. The management of the patients can be individualized based on clinical presentation.

2823 Spleen Rupture Secondary Colonoscopy Is a Rising Epidemic

INTRODUCTION: Colonoscopy is a safe and routine procedure to evaluate large bowel for diagnostic and therapeutic purposes. Common post procedure complications include bleeding and perforation of gut but rarely splenic Injury. METHODS: A structured search on four databases was done and 68 articles were selected. Three reviewers extracted data into the excel sheet identifying the reason of colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcome of all patients with spleen injury. RESULTS: The mean age of all the patients was 62.7 SD 15.7 years, 36% male and 64% female. About 22% had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma, spleen laceration and spleen avulsion. The most common reason was screening colonoscopy (46%) followed by diagnostic colonoscopy (28%). About 87% patients presented with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%). While minor spleen hematomas and lacerations were managed conservatively (38%). Interestingly, 6% patients were managed with proximal splenic artery splenic embolization (PSAE) and 4% were managed with laparoscopy. The overall mortality was about 10% while 77% had successful recovery. The reason of colonoscopy against presentation specifically abdominal pain showed no statistical significance P = 0.69. Spleen rupture and injury were the most common reason was screening colonoscopy followed by colonoscopy done for bleeding evaluation (not statistically significant). There was no significant association found between the reason of colonoscopy and type of spleen injury management (P 0.89). It is interesting to note that significantly high (74%) of the spleen rupture patients were managed with splenectomy while the rest were managed with conservative management in spleen injury group (P value 0.04) (Figure 1). The strength of association between the management and spleen injury was moderately strong at at a cramer’s V 0.34. The Fisher exact test for the type of spleen injury with the outcome was significant (P = 0.028) indicating a high mortality with spleen rupture. CONCLUSION: Spleen rupture due to colonoscopy is an increasing concern and should physicians should be aware of it as it has been associated with a high mortality. The management of the patients can be individualized based on clinical settings.