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Background: The aim of this systematic review was to assess the estimated incidence of pseudoaneurysm (PSA) with follow‐up computed tomography (CT) for adult splenic injury with nonoperative management (NOM). Methods: A systematic literature search was conducted in MEDLINE, Central, CINAHL, Clinical Trials, and ICTRP databases between January 1, 2010, and December 31, 2023. Quality assessment was performed using the Risk of Bias in Non‐randomized Studies of Exposures (ROBINS‐E) tool. Adult splenic injury patients who were initially managed with NOM and followed‐up by protocolized CT were included. The primary outcome was the incidence of delayed PSA. Secondary outcome measures were delayed angiography and delayed splenectomy. Subgroup analyses were performed between NOM patients without initial splenic angioembolization (SAE) and NOM patients with initial SAE. Results: Twelve studies were enrolled, including 11 retrospective studies and one prospective study, with 1746 patients in total. The follow‐up CT rate in the included patients was 94.9%. The estimated incidence of PSA was 14% (95% confidence interval (CI), 8%–21%). The estimated delayed angiography and delayed splenectomy incidence rates were 7% (95% CI, 4%–12%) and 2% (95% CI, 1%–6%), respectively. Subgroup analyses showed that the estimated PSA incidence was 12% in NOM patients without initial SAE (95% CI, 7%–20%) and was also 12% in NOM patients with SAE (95% CI, 5%–24%). Conclusions: The estimated incidence of delayed PSA after follow‐up CT for adult splenic injury with NOM was 14%. The estimated incidence of PSA in NOM with initial SAE was similar to that in NOM without initial SAE. [ABSTRACT FROM AUTHOR]

Background: Multi-detector contrast-enhanced abdominal computed tomography (CT) allows for the accurate detection and classification of traumatic splenic injuries, leading to improved patient management. Their effective use requires rapid study interpretation, which can be a challenge on busy emergency radiology services. A machine learning system has the potential to automate the process, potentially leading to a faster clinical response. This study aimed to create such a system. Method: Using the American Association for the Surgery of Trauma (AAST), spleen injuries were classified into 3 classes: normal, low-grade (AAST grade I-III) injuries, and high-grade (AAST grade IV and V) injuries. Employing a 2-stage machine learning strategy, spleens were initially segmented from input CT images and subsequently underwent classification via a 3D dense convolutional neural network (DenseNet). Results: This single-centre retrospective study involved trauma protocol CT scans performed between January 1, 2005, and July 31, 2021, totaling 608 scans with splenic injuries and 608 without. Five board-certified fellowship-trained abdominal radiologists utilizing the AAST injury scoring scale established ground truth labels. The model achieved AUC values of 0.84, 0.69, and 0.90 for normal, low-grade injuries, and high-grade splenic injuries, respectively. Conclusions: Our findings demonstrate the feasibility of automating spleen injury detection using our method with potential applications in improving patient care through radiologist worklist prioritization and injury stratification. Future endeavours should concentrate on further enhancing and optimizing our approach and testing its use in a real-world clinical environment. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) continues to be a major cause of morbidity in trauma. It is unclear whether the type of hemorrhage control procedure (i.e., splenectomy versus angioembolization) is associated with an increased risk of VTE. We hypothesize that hemodynamically stable patients undergoing angioembolization for blunt high-grade splenic injuries have lower rates of VTE compared to those undergoing splenectomy. The American College of Surgeons Trauma Quality Program dataset from 2017 to 2019 was queried to identify all patients with American Association for the Surgery of Trauma grade 3-5 blunt splenic injuries. Outcomes including VTE rates were compared between those who were managed with splenectomy versus angioembolization. Propensity score matching (1:1) was performed adjusting for age, sex, initial vital signs, Injury Severity Score, and splenic injury grade. The analysis included 4698 matched patients (splenectomy [ n = 2349] and angioembolization [ n = 2349]). The median (interquartile range) age was 41 (27-58) years and 69% were male. Patients were well matched between groups. Angioembolization was associated with significantly lower VTE than splenectomy (2.2% versus 3.4%, P = 0.010) despite less use of VTE chemoprophylaxis (70% versus 80%, P < 0.001), as well as a relative delay in initiation of chemoprophylaxis (44 h versus 33 h, P < 0.001). Hospital and intensive care unit length of stay and mortality were also significantly lower in the angioembolization group. Angioembolization is associated with a significantly lower incidence of VTE than splenectomy. Thus, angioembolization should be considered for initial management of hemodynamically stable patients with high-grade blunt splenic injuries in whom laparotomy is not otherwise indicated. [ABSTRACT FROM AUTHOR]

Background Method Results Conclusion Non‐operative management of splenic injuries has significantly increased in the last decade with an increased emphasis on splenic preservation. This shift was assisted by increased availability of angioembolization, however, potential geographical variability in access exists in Aotearoa New Zealand (AoNZ). The aim of this study was to assess the management of splenic injury across AoNZ.Five‐year retrospective study of all patients admitted to AoNZ hospitals with blunt major trauma and a splenic injury. Patients were identified using the National Trauma Registry and cross‐referenced with the National Minimum Data Set to determine their management. The primary outcome was the non‐operative rate.Seven hundred seventy‐three patients were included. Four hundred sixty‐nine presented to a tertiary major trauma hospital and 304 to a secondary major trauma hospital. A difference was found in the rate of non‐operative management between tertiary and secondary hospitals (P = 0.019). The rate of non‐operative management was similar in mild (P = 0.814) and moderate (P = 0.825) injuries, however, significantly higher in severe injuries in tertiary hospitals (P = 0.009). No difference in mortality rate was found.This study found a difference in the management of splenic injuries between tertiary and secondary major trauma hospitals; predominantly due to a higher rate of operative management in patients with severe injuries at secondary hospitals. Despite this, no difference in mortality rate was found between tertiary and secondary hospitals. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to elucidate the treatment approach for blunt splenic injuries concurrently involving the aorta. We hypothesized that non-operative management failure rates would be higher in such cases, necessitating increased hemorrhage control surgeries. Methods: Data from the Trauma Quality Improvement Program spanning 2017 to 2019 were utilized. All patients with blunt splenic trauma were considered for inclusion. We conducted comparisons between blunt splenic trauma patients with and without thoracic or abdominal aortic injuries to identify any potential disparities in treatment. Results: Among the 32,051 patients with blunt splenic injuries during the study period, 752 (2.3%) sustained concurrent aortic injuries. Following 2:1 propensity score matching, it was determined that the presence of aortic injuries did not significantly affect the utilization of splenic transarterial angioembolization (TAE) (7.2% vs. 8.7%, p = 0.243) or the necessity for splenectomy or splenorrhaphy (15.3% vs. 15.7%, p = 0.853). Moreover, aortic injuries were not a significant factor contributing to TAE failure, regardless of the location or severity of the injury. Patients with simultaneous splenic and aortic injuries required more red blood cell transfusion within first 4 hours (0 ml [0, 900] vs. 0 ml [0, 650], p = 0.001) and exhibited a higher mortality rate (10.6% vs. 7.9%, p = 0.038). Conclusion: This study demonstrated that patients with concurrent aortic and splenic injuries presented with more severe conditions, higher mortality rates, and extended hospital stays. The presence of aortic injuries did not substantially influence the utilization of TAE or the necessity for splenectomy or splenorrhaphy. Patients of this type can be managed in accordance with current treatment guidelines. Nonetheless, given their less favorable prognosis, they necessitate prompt and proactive intervention. [ABSTRACT FROM AUTHOR]

Splenic rupture in haemodynamically unstable patients has traditionally been managed with splenectomy. This case report discusses the successful management of atraumatic splenic rupture, a rare but life-threatening complication of Epstein-Barr virus (EBV) infection, in a hemodynamically unstable patient. The patient, diagnosed with infectious mononucleosis (IM) secondary to EBV, presented with severe abdominal pain and a syncopal episode. Imaging revealed an American Association for the Surgery of Trauma (AAST) grade III splenic injury, which was subsequently upgraded to a grade IV injury on repeat imaging. The patient's condition deteriorated even with initial resuscitation, leading to splenic angioembolization. The procedure was successful and the patient was discharged after 5 days. This case highlights the efficacy of splenic artery embolization (SAE) in haemodynamically unstable patients with atraumatic splenic rupture, particularly in centers with interventional radiology resources, offering an alternative to splenectomy and its associated complications.

Splenic injury is an extremely rare complication of endoscopic retrograde cholangiopancreatography (ERCP). There are only 34 cases reported in the literature up to now. Based on a case of a 72-year-old man, who after ERCP due to choledocholithiasis developed a large perisplenic and subcapsular hematoma, we carried out an extensive review of all cases of ERCP-induced splenic injury found in the literature. We searched PubMed/Medline and Google Scholar till 15 April 2023, for published case reports and series using the following terms: splenic injury after ERCP, ERCP-induced splenic injury, and post-ERCP splenic trauma. The case reports included were in English, Spanish, and German literature. We attempt to discuss the possible clinical image, the available diagnostic methods, the potential treatment alternatives, and predisposing factors related to this entity. Furthermore, a theory of a possible mechanism of this injury is discussed and supported schematically. The ERCP-induced splenic injury is rare and a high index of suspicion is needed for diagnosis. Therefore, we present two diagnostic algorithms, which according to our opinion may assist the evaluation of this complication and lead to early accurate diagnosis and appropriate management. Collectively, our findings support that although ERCP-induced splenic injury is an unexpected/unusual complication of ERCP, following the proper steps can be timely diagnosed and treated. [ABSTRACT FROM AUTHOR]

Abstract Colonoscopy is a common procedure for screening of colon cancer. Although complications are rare, recently there have been reports of splenic injury associated with colonoscopy. Its causes are not clear. Herein, we report an 84‐year‐old man who underwent a colonoscopy for an annual routine examination. The colonoscopy was performed with moderate difficulty due to loop formation and took about 50 min. After the examination, he developed syncope, sweating, and abdominal distention with low blood pressure. Plain computed tomography revealed ascites, and the patient was hospitalized with close monitoring. The following day, his hemoglobin level was decreased by about 3.0 g/dL. Contrast‐enhanced computed tomography revealed the splenic injury. The patient was hemodynamically stable and was treated conservatively. Splenic injury is an uncommon complication of colonoscopy; however, it may cause hemodynamic instability. Physicians performing colonoscopies should be aware of this potential complication.

Abstract Background Splenic abscess is a rare disease, with incidence of 0.2–0.7% in previous studies. It often appears with left upper quadrant abdominal pain, fever, chills. Splenic abscess often happens because of hematogenous spreading of infections, endocarditis, angioembolization and some other rare reasons. Treatment relies on one of these two methods: percutaneous drainage or surgery. Case presentation A 68-year-old diabetic Asian female (Asian woman) presented with generalized abdominal pain, low blood pressure, tachycardia, fever, lethargy and elevated level of blood sugar. She had history of conservative therapy in intensive care unit due to blunt abdominal trauma and splenic injury. She had a huge splenic abscess in ultrasonography and computed tomography scan so she went under splenectomy. Our patient had a splenic abscess without performing any intervention like angioembolization. Conclusion Immune compromised patients who are selected for nonoperative management after splenic injury need close follow up and evaluating about abscess formation for at least 2 weeks. Early diagnosis and treatment with two methods including percutaneous drainage or splenectomy should be considered and it depends on patient’s risk factors, vital signs, general conditions and presence or absence of sepsis.

Background: The spleen is one of the most injured organs following blunt abdominal trauma. The management options can be either operative or non-operative management (NOM) with either conservative management or splenic artery embolization. The implementation of CT in emergency departments allowed the use of CT imaging as a primary screening tool in early decision-making. Consecutively, new splenic injury scoring systems, such as the CT severity index (CTSI) reported was established. Aim: The main aim of this study is to evaluate the effect of the implementation of CTSI scoring system on the management decision and outcomes in patients with blunt splenic trauma over 8 years in a level 1 trauma center. Methods: This is a retrospective study including all adult patients with primary splenic trauma, having NOM and admitted to our hospital between 2013 and 2021. Results: The analyses were conducted on ninety-nine patients. The average sample age was 32.7 ± 12.3 years old. A total of (63/99) patients had splenic parenchyma injury without splenic vascular injury. There is a statistically significant association between CTSI grade 3 injury and the development of delayed splenic vascular injury (p

After an initial traumatic brain injury, it was hypothesized that systemic inflammation contributes to secondary brain injury. Our study aims to observe the effect of splenectomy on mortality in patients with concomitant splenic injury and head injury. A retrospective study which involved 243 cases, out of which 119 patients had splenectomy for grade 4,5 splenic injury or hemodynamic instability. We observed that the mortality was 67% in moderate head injury patients and 72.7% in severe head injury patients who underwent splenectomy. We conclude that the mortality in patients with concomitant splenic injury and head injury patients increases with increase in severity of head injury. [ABSTRACT FROM AUTHOR]

Background: Nonoperative management (NOM) is the standard treatment for hemodynamically stable blunt splenic injury (BSI). However, NOM failure is a significant source of morbidity and mortality. We developed a clinical risk scoring system for NOM failure in BSI. Methods: Data from the Japanese Trauma Data Bank from 2008 to 2018 were analyzed. Eligible patients were restricted to those who underwent NOM with high-grade BSI (Organ Injury Scale ≥3). The primary outcome was a predictive score for NOM failure based on risk estimation. Results: There were 1651 patients included in this analysis, among whom 110 (6.7%) patients had NOM failure. Multivariate analysis identified seven variables associated with failed NOM: systolic blood pressure, Glasgow coma scale, Injury Severity Score, other concomitant abdominal injury, pelvic injury, high-grade BSI, and angioembolization. An eight-point predictive score was developed with a cut-off of greater than 5 points (specificity, 98.2%; sensitivity, 25.5%) with an area under the curve of 0.81. Conclusion: The clinical predictive score had good ability to predict NOM failure and may help surgeons to make better decisions for BSI.

Background: Blunt splenic injuries are common traumatic injuries. Severe injuries may require blood transfusion, procedural, or operative intervention. Conversely, patients with low-grade injuries and normal vital signs frequently do not require intervention. The level and duration of monitoring required to safely manage these patients are unclear. We hypothesize that low-grade splenic trauma has a low rate of intervention and may not require acute hospitalization. Methods: This retrospective descriptive analysis included patients admitted to a level I trauma center with low injury burden (injury severity score <15) and The American Association for the Surgery of Trauma (AAST) grade 1 (G1) and 2 (G2) splenic injuries between January 2017 and December 2019 using the Trauma Registry of the American College of Surgeons (TRACS). The primary outcome was the need for any intervention. Secondary outcomes included time to intervention and length of stay. Results: 107 patients met inclusion criteria. 87.9% required no intervention. 9.4% required blood products, with a median time to transfusion of 7.4 hours from arrival. All patients receiving blood products had extenuating circumstances such as bleeding from other injuries, anticoagulant use, or medical comorbidities. 2 patients required splenic artery embolization, one presenting with return precautions 9 days post-injury and 1 with significant comorbidities. One patient with concomitant bowel injury required splenectomy. Conclusions: Low-grade blunt splenic trauma has a low rate of intervention, which typically occurs within the first 12 hours of presentation. This suggests that outpatient management with return precautions may be appropriate for select patients after a short interval of observation. [ABSTRACT FROM AUTHOR]

Background: Splenic abscess is a rare disease, with incidence of 0.2–0.7% in previous studies. It often appears with left upper quadrant abdominal pain, fever, chills. Splenic abscess often happens because of hematogenous spreading of infections, endocarditis, angioembolization and some other rare reasons. Treatment relies on one of these two methods: percutaneous drainage or surgery. Case presentation: A 68-year-old diabetic Asian female (Asian woman) presented with generalized abdominal pain, low blood pressure, tachycardia, fever, lethargy and elevated level of blood sugar. She had history of conservative therapy in intensive care unit due to blunt abdominal trauma and splenic injury. She had a huge splenic abscess in ultrasonography and computed tomography scan so she went under splenectomy. Our patient had a splenic abscess without performing any intervention like angioembolization. Conclusion: Immune compromised patients who are selected for nonoperative management after splenic injury need close follow up and evaluating about abscess formation for at least 2 weeks. Early diagnosis and treatment with two methods including percutaneous drainage or splenectomy should be considered and it depends on patient's risk factors, vital signs, general conditions and presence or absence of sepsis. [ABSTRACT FROM AUTHOR]

BackgroundThe optimal level of care for hemodynamically stable patients with isolated blunt hepatic, renal, or splenic injuries (solid organ injuries [SOIs]) is unknown. We sought to characterize interhospital variability in intensive care unit (ICU) admission of such patients and to determine whether greater hospital-level ICU use would be associated with improved outcomes.MethodsWe conducted a retrospective cohort study using the 2015 and 2016 National Trauma Data Bank. We included adult patients with blunt trauma with SOIs with an Abbreviated Injury Scale score of 2 to 4. We excluded patients with other significant injuries, hypotension, or another indication for ICU admission, and hospitals with less than 10 eligible patients. We categorized hospitals into quartiles based on the proportion of eligible patients admitted to an ICU. The primary outcome was a composite of organ failure (cardiac arrest, acute lung injury/acute respiratory failure, or acute kidney injury), infection (sepsis, pneumonia, or catheter-related blood stream infection), or death during hospitalization.ResultsAmong 14,312 patients at 444 facilities, 7,225 (50%), 5,050 (35%), and 3,499 (24%) had splenic, hepatic, and renal injuries, respectively. The median proportion of ICU use was 44% (interquartile range, 27-59%, range 0-95%). The composite outcome occurred in 180 patients (1.3%), with death in 76 (0.5%), organ failure in 97 (0.7%), and infection in 53 (0.4%). Relative to hospitals with the lowest ICU use (quartile 1), greater hospital-level ICU use was not associated with decreased likelihood of the composite outcome (adjusted odds ratios, 1.31; 95% confidence interval [95% CI], 0.88-1.95; 0.81; 95% CI, 0.52-1.26; and 0.94; 95% CI, 0.62-1.43 for quartiles 2-4, respectively) or its components. Unplanned ICU transfer was no more likely with lower hospital-level ICU use.ConclusionAdmission location of stable patients with isolated mild to moderate abdominal SOIs is variable across hospitals, but hospitalization at a facility with greater ICU use is not associated with substantially improved outcomes.Level of evidenceTherapeutic/care management, Level IV.

Abstract Background The spleen is one of the most frequently injured abdominal organs during trauma, which can result in intraperitoneal bleeding of life-threatening magnitude. Although splenic injury secondary to trivial trauma comprises a minor fraction of abdominal injuries, undiagnosed or delayed diagnosis may result in a complicated clinical course. Case presentation One such event is presented here, wherein a late diagnosis of an advanced grade splenic injury following a trivial trauma initially presented in disguise as acute myocardial ischaemia in a previously healthy South Asian woman in her late 30s. Emergency laparotomy and splenectomy were performed with simultaneous massive transfusion for a 3.5-L blood loss. She subsequently had an uncomplicated clinical course with regular surgical follow-up. Conclusion Splenic injuries might present with ambiguous symptoms such as atypical chest pain and shoulder pain, necessitating attending clinicians to have a high degree of suspicion, especially in busy units such as the emergency department (ED).

Introduction: Colonoscopy is a basic tool in the study of pathology of the colorectal area, as well as one of the pillars of colon and rectal cancer screening. However, it is not a risk-free procedure, some of them with high morbimortality. Case Report: 55-year-old male with chronic alcoholism and hepatopathy due to HCV, COPD. During a study for diarrhea, an ultrasound of the abdomen revealed a 7 mm pancreas tumor, and a diagnostic colonoscopy showed no significant alterations. With the suspicion that the pancreatic lesion could be the cause of the diarrhea, an abdominal scan was performed showing a subcapsular collection at the splenic level of 11 x 3 cm compatible with hematoma without signs of active bleeding. Due to the hemodynamic stability, conservative management was decided, with worsening abdominal pain and hypotension in the following 12 hours. A new imaging test showed an enlarged splenic hematoma and free abdominal fluid suggestive of hemoperitoneum. Urgent surgery found hemoperitoneum secondary to splenic lesion and splenectomy was required. Conclusion: The presence of a possible iatrogenic splenic lesion should be considered in the differential diagnosis in a patient with acute onset abdominal pain and anemia or hemodynamic status alteration within the first 24-48 hours after colonoscopy. [ABSTRACT FROM AUTHOR]

Background: With the rise of laparoscopic surgery, there have been reports of blunt trauma situations where a laparoscopic approach was used, particularly for partial splenectomies. However, the evidence has not yet met acceptable criteria. This study aimed to evaluate the safety, feasibility, and outcome of laparoscopic splenectomy in patients with blunt splenic injury. Patients and methods: This clinical trial study was carried out in Zagazig University hospital including 30 patients with splenic injuries caused by blunt abdominal trauma who were admitted to the Emergency Department of Zagazig University hospitals during the period from March 2020 to September 2020 to evaluate the feasibility and outcome of laparoscopic splenectomy in patients with blunt splenic injury. The diagnosis of splenic injury caused by blunt splenic trauma was confirmed on basis of Radiological investigations and Laboratory investigations. Results: in this study, Only 2 cases 6.7% converted to open. Overall complication founded in 4 cases with 13.3%. Conclusion: Laparoscopic Splenectomy was safe and technically feasible when applied carefully to patients with blunt abdominal trauma, decreasing the hospitalization time and postoperative ICU stay. [ABSTRACT FROM AUTHOR]

Tris(1,3-dichloro-2-propyl) phosphate (TDCPP) is an organophosphorus flame retardant that has been utilized in recent years as a primary replacement for polybrominated diphenyl ethers (PBDEs) in a wide variety of fire-sensitive applications. However, the impact of TDCPP on the immune system has not been fully determined. As the largest secondary immune organ in the body, the spleen is considered to be an important study endpoint for determining immune defects in the body. The aim of this study is to investigate the effect of TDCPP toxicity on the spleen and its possible molecular mechanisms. In this study, for 28 consecutive days, TDCPP was administered intragastrically (i.g), and we assessed the general condition of mice by evaluating their 24 h water and food intake. Pathological changes in spleen tissues were also evaluated at the end of the 28-day exposure. To measure the TDCPP-induced inflammatory response in the spleen and its consequences, the expression of the critical players in the NF-κB pathway and mitochondrial apoptosis were detected. Lastly, RNA-seq was performed to identify the crucial signaling pathways of TDCPP-induced splenic injury. The results showed that TDCPP intragastric exposure triggered an inflammatory response in the spleen, likely through activating the NF-κB/IFN-γ/TNF-α/IL-1β pathway. TDCPP also led to mitochondrial-related apoptosis in the spleen. Further RNA-seq analysis suggested that the TDCPP-mediated immunosuppressive effect is associated with the inhibition of chemokines and the expression of their receptor genes in the cytokine–cytokine receptor interaction pathway, including four genes of the CC subfamily, four genes of the CXC subfamily, and one gene of the C subfamily. Taken together, the present study identifies the sub-chronic splenic toxicity of TDCPP and provides insights on the potential mechanisms of TDCPP-induced splenic injury and immune suppression. [ABSTRACT FROM AUTHOR]

An 82-year-old woman fell down the stairs and was brought to our hospital. When she came to our hospital, she had a left acute epidural hematoma, brain contusion, and splenic injury. During plain computed tomography (CT) imaging, hypotension and deteriorated level of consciousness was observed, and simultaneous head and abdominal surgery was performed to control intracranial hematoma growth and hemorrhagic shock. The head was positioned in right rotation and the trunk in supine position, and craniotomy and splenectomy were performed simultaneously. Simultaneous head and abdominal surgery is a very effective treatment strategy for multiple trauma because it does not require repositioning of the patient.

Introduction: Colonoscopy is a frequent and routine procedure, and even though it is considered safe, it can have complications. The splenic traumatism is an infrequent complication, but potentially mortal. Clinical Case: Woman 75 years old, consulted for abdominal pain and distension after a colonoscopy. Physical examination revealed pain in epigastric and left hypochondrium without peritoneal irritation. Urgent TC scan reported a splenic hematoma of 10 x 2,6 cm, without active bleeding. She received non-operative treatment with a favorable evolution. Conclusion: The management depends on the hemodynamic stability, the grade of injury and the presence of and active bleeding. In selected cases, non-operative treatment is an option that avoids unnecessary surgeries, even if the patient must stay 48-72 h hospitalized in an Intensive Care Unit for a strict monitoring of vital signs. Although the splenic injury secondary a colonoscopy is an infrequent complication, it can be potentially mortal if it is not diagnosed. [ABSTRACT FROM AUTHOR]

Abstract Background Blunt abdominal solid organ injury is common and is often managed nonoperatively. Clinicians must balance risk of both hemorrhage and thrombosis. The optimal timing of pharmacologic venous thromboembolism prophylaxis (VTEp) initiation in this population is unclear. The objective was to evaluate early (

Splenic artery embolization (SAE) has become a favored alternative to splenectomy, offering a less invasive intervention for injured spleens while preserving spleen function. However, our understanding of the role that hemodynamics plays during embolization remains limited. In this study, we utilized patient-specific computational fluid dynamics (CFD) simulations to study distal and proximal embolization strategies commonly used in SAE. Detailed 3D computer models were constructed considering the descending aorta, various major visceral arteries, and the iliac arteries. Subsequently, the blood flow and pressure associated with different coil placement locations in proximal embolization were studied considering the collateral vessels. Coil induced variations in pressure fields were quantified and compared to baseline. The coil induced flow stagnation was also quantified with particle residence time. Distal embolization was modeled with Lagrangian particle tracking and the effect of particle size, release location, and timing on embolization outcome was studied. Our findings highlight the crucial role of collateral vessels in maintaining blood supply to the spleen following proximal embolization. It was demonstrated that coil location can affect distal pressure and that strategic coil placement guided by patient-specific CFD simulations can further reduce this pressure as desired. Additionally, the results point to the critical roles that particle size, release timing, and location play in distal embolization. Our study provides an early attempt to use patient-specific computer modeling for optimizing embolization strategies and ultimately improving patient outcomes during SAE procedures. [ABSTRACT FROM AUTHOR]

Over recent decades, splenic angioembolization (SAE) as an adjunct to non-operative management (NOM) has emerged as a prominent intervention for patients with blunt splenic injuries (BSI). SAE improves patient outcomes, salvages the spleen, and averts complications associated with splenectomy. This systematic review aimed to evaluate the failure rate and complications related to SAE in patients with BSI. A systematic literature search (PubMed, SCOPUS, and Cochrane Library) focused on studies detailing splenic angioembolization in blunt trauma cases. Articles that fulfilled the predetermined inclusion criteria were included. This review examined the indications, outcomes, failure rate, and complications of SAE. Among 599 identified articles, 33 met the inclusion criteria. These comprised 29 retrospective studies, three prospective studies, and one randomized control trial. The analysis encompassed 25,521 patients admitted with BSI and 3,835 patients who underwent SAE. The overall failure rate of SAE was 5.3 %. Major complications predominantly were rebleeding (4.8 %), infarction (4.6 %), and abscess formation (4 %). Minor complications were fever (18.4 %), pleural effusion (13.1 %), and coil migration (3.9 %). Other complications included splenic atrophy, splenic cyst, hematoma, and access site complications such as splenic/femoral dissection. Overall, post embolization mortality was 0.08 %. SAE is a valuable adjunct in managing BSI, with a low failure rate. However, this treatment modality is not without the risk of potentially serious complications. [ABSTRACT FROM AUTHOR]

Colonoscopy, while generally safe, can rarely lead to severe complications such as splenic injury. This article reports a case of splenic injury post-colonoscopy, highlighting clinical challenges, diagnostic approaches, and treatment strategies. The goal is to raise awareness among healthcare professionals and enhance knowledge on managing such complications. A 60-year-old woman with chronic constipation underwent a challenging colonoscopy. Twelve hours later, she had acute abdominal pain, bloating, and anemia. Examination revealed tachycardia and a distended abdomen. Urgent CT showed splenic hematoma and hemoperitoneum. Initially managed conservatively with fluids and transfusions, she developed worsening tachycardia and persistent anemia, necessitating emergency laparotomy. Surgery confirmed significant hemoperitoneum and bleeding splenic lesion, leading to splenectomy. She stabilized and was discharged on the fifth postoperative day with antibiotics and vaccinations. Splenic injury, though rare, is a serious complication of colonoscopy, occurring in 0.002 % to 0.033 % of cases. Symptoms include abdominal pain, left shoulder pain, dizziness, and syncope. Prompt diagnosis with contrast-enhanced CT, which identifies 98.5 % of injuries, is crucial. Treatment ranges from conservative management to emergency splenectomy, based on injury severity and patient stability. Non-operative management is often successful in stable patients, while splenectomy may be necessary for those with significant hemodynamic instability. Early recognition and appropriate treatment are essential for favorable outcomes. Splenic injury is a rare but severe complication of colonoscopy. Early recognition and appropriate management are crucial for positive outcomes. Conservative treatment is often effective, but surgery may be needed for severe cases. • " Rare Complication ": Highlights the rare but serious occurrence of splenic injury post-colonoscopy and the need for rapid recognition. • " Diagnostic Challenges ": Details the diagnostic difficulties, including atypical symptoms and the need for accurate imaging. • " Management Strategies ": Explores treatment options, including conservative vs. surgical approaches based on injury severity and patient stability. [ABSTRACT FROM AUTHOR]

Background and Objectives: Nonoperative management (NOM) of splenic injury is the standard treatment for all splenic injury patients who are hemodynamically stable. However, it may be a challenge in developing countries with limited intensive care resources. This study aimed to review the outcomes and identify the factors of unsuccessful NOM of splenic injury in a Level 1 trauma center in Thailand. Materials and Methods: This was a retrospective review that collected data from the trauma registry. The enrolled patients had a splenic injury and underwent NOM from 2009 to 2016. Failure of NOM was defined as the need for an operation on the spleen after NOM. The outcomes of NOM were described, and the predictors for failure of NOM were identified. Results: Seventy-two splenic injury patients were included in the study. The majority of patients were involved in a motorcycle crash (56%). The average injury severity score was 20. Fifty-nine patients (89%) were successfully treated as NOM. Six patients underwent embolization (8%), and none of the patients required operative management. Univariate analysis showed that hemoperitoneum in ≥4 regions (odds ratio [OR] 3.96, 95% confidence interval [CI] 0.79–25.53; (P = 0.05) and received packed red cells >2 units within 24 h (OR 20, 95% CI 2.15–242; P = 0.003) were significantly associated with failure of NOM. Conclusions: NOM of splenic injury can be performed successfully in a trauma center in a developing country. Splenic angioembolization might be helpful to increase the success rate. The amount of hemoperitoneum was a significant predictor of failed NOM.

There are well-established protocols for venous thromboembolism prophylaxis in many patients with a variety of medical and surgical conditions. However, no studies have been published regarding therapeutic anticoagulation in polytrauma patients, who usually present with multiple injuries including vascular injuries and solid organ injuries, which would require therapeutic anticoagulation that increases the risk of bleeding from abdominal solid organ injuries. Here, we present the case of a 45-year-old male, who had a motor vehicle collision and was found to have a grade III splenic injury and had to be started on therapeutic anticoagulation due to popliteal artery injury repair. Our patient was anticoagulated with low-molecular-weight heparin. He had no bleeding complications, and his splenic injury was successfully managed nonoperatively.

Background Splenic injury due to chest compressions is a rare and fatal complication that occurs immediately after cardiopulmonary resuscitation. Case Presentation Cardiopulmonary resuscitation was carried out using a mechanical chest compression device in a 74‐year‐old Japanese female patient who underwent cardiac arrest. Computed tomography postresuscitation revealed bilateral anterior rib fractures. Other traumatic findings were not observed. Coronary angiography revealed no new lesions; the cause of the arrest was hypokalemia. She received mechanical support with venoarterial extracorporeal membrane oxygenation and multiple antithrombotic agents. Her hemodynamic and coagulative condition became life‐threatening on day 4; abdominal ultrasound revealed massive bloody ascites. Only a minor splenic laceration was observed intraoperatively, despite massive bleeding. Furthermore, her condition stabilized after splenectomy and blood transfusion. Venoarterial extracorporeal membrane oxygenation was discontinued on day 5. Conclusion In patients with postcardiac arrest, delayed bleeding due to minor visceral injury should be considered, particularly for coagulation abnormalities.

Aim Substantial variations in the utilization of angioembolization have been reported internationally. However, the existence of variations in the utilization of angioembolization in Japan is currently unknown. Methods This was a cross‐sectional study using data from a nationwide trauma registry in Japan. Of the 4,896 registered adult patients with splenic injury, we investigated 3,319 patients in the top 25% of the hospitals that registered the highest number of splenic injury patients in the Japan Trauma Data Bank. The primary outcome of this study was initial angioembolization. We calculated the expected initial angioembolization rates using multiple regression analysis adjusted for patient factors. In addition, we evaluated the range of observed‐to‐expected initial splenic angioembolization ratio for each hospital. Moreover, we assessed whether this ratio was increased with time. Results The frequency of initial splenic angioembolization ranged from 0% to 52%. The median expected initial angioembolization rate, calculated through multiple logistic regression analysis, was 19.7%. The observed‐to‐expected initial splenic angioembolization ratio for each hospital ranged from 0 to 2.36. The observed initial angioembolization rate tended to increase with time (P

Background: The spleen is one of the most frequently injured abdominal organs during trauma, which can result in intraperitoneal bleeding of life-threatening magnitude. Although splenic injury secondary to trivial trauma comprises a minor fraction of abdominal injuries, undiagnosed or delayed diagnosis may result in a complicated clinical course. Case presentation: One such event is presented here, wherein a late diagnosis of an advanced grade splenic injury following a trivial trauma initially presented in disguise as acute myocardial ischaemia in a previously healthy South Asian woman in her late 30s. Emergency laparotomy and splenectomy were performed with simultaneous massive transfusion for a 3.5-L blood loss. She subsequently had an uncomplicated clinical course with regular surgical follow-up. Conclusion: Splenic injuries might present with ambiguous symptoms such as atypical chest pain and shoulder pain, necessitating attending clinicians to have a high degree of suspicion, especially in busy units such as the emergency department (ED). [ABSTRACT FROM AUTHOR]

Despite significant interest in trauma to the spleen over the past 130 years, splenectomy remained the preferred approach to splenic injures in children till the late 1950s and even later in adults. With recognition of the immunologic importance of the spleen and improvements in diagnostic imaging and angioembolization, there are now four pathways for the child or adult admitted with a possible, likely, or diagnosed injury to the spleen. These include the following: (1) operation with splenectomy; (2) operation with splenorrhaphy or partial splenectomy; (3) nonoperative management (observation); and (4) nonoperative management with splenic arteriography and possible angioembolization. This review will focus on the latter two options. [ABSTRACT FROM AUTHOR]

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Colonoscopy is a widely performed diagnostic and therapeutic procedure essential for the screening, diagnosis, and management of various colorectal conditions. It is a routine and relatively safe procedure. Unfortunately, sometimes complications arise, one of the rarest being splenic injury. A splenic hematoma following colonoscopy can lead to significant morbidity and can be fatal if not promptly recognized and managed. We report a case of a 58-year-old female who initially refused imaging after presenting to the ED with abdominal pain following her procedure, but then presented again days later and was found to have a splenic hematoma and hemoperitoneum. She was ultimately managed medically and after an uneventful hospital course and was able to be discharged without requiring a splenectomy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Howell et al.)

Delayed Splenic Rupture (DSR) is a rare but well-known manifestation of Blunt Splenic Injury (BSI), which most commonly occurs following a car accident, a fall from a great height, or a direct blow to the left thorax or abdomen. If the history of trauma is remote or unknown, the diagnosis can be difficult or missed, and a high index of suspicion is not warranted. Regardless of the time and mechanism of the inciting event, DSR should be considered in the differential diagnosis of an acute surgical abdomen. We present a case of DSR in an 81-year-old woman caused by a remote minor blunt abdominal trauma four weeks prior to her admission to our emergency department for acute abdominal pain and hemorrhagic shock (ATLS CLASS III). Starting with this case report, we conducted a literature review on the subject in order to raise awareness, knowledge, and understanding of DSR among emergency clinicians.

Delayed Splenic Rupture (DSR) is a rare but well-known manifestation of Blunt Splenic Injury (BSI), which most commonly occurs following a car accident, a fall from a great height, or a direct blow to the left thorax or abdomen. If the history of trauma is remote or unknown, the diagnosis can be difficult or missed, and a high index of suspicion is not warranted. Regardless of the time and mechanism of the inciting event, DSR should be considered in the differential diagnosis of an acute surgical abdomen. We present a case of DSR in an 81-year-old woman caused by a remote minor blunt abdominal trauma four weeks prior to her admission to our emergency department for acute abdominal pain and hemorrhagic shock (ATLS CLASS III). Starting with this case report, we conducted a literature review on the subject in order to raise awareness, knowledge, and understanding of DSR among emergency clinicians. [ABSTRACT FROM AUTHOR]

Abstract Background Many pancreatic pseudocysts spontaneously resolve, but larger or symptomatic pseudocysts may require procedural management. Though endoscopic ultrasound guided approaches are standard of care and have high success rates, complications can include bleeding, infection, and splenic perforation. This patient case report details an unusual series of complications of endoscopic cystogastrostomy that should encourage clinicians to evaluate for anatomic disruptions caused by mass effects of pancreatic pseudocysts prior to endoscopic pseudocyst drainage. Case presentation A 53-year-old African American male with a past medical history notable for alcohol use disorder, chronic pancreatitis, and insulin dependent diabetes presented with a 4-day history of left upper quadrant abdominal pain. Computed tomography imaging with contrast revealed enlargement of a known pancreatic pseudocyst to 15.9 × 10.4 cm. Due to pseudocyst size and the patient’s symptoms, endoscopic cystogastrostomy stent placement was performed. However, postprocedurally, he developed leukocytosis to 19,800 cells/m3 (from 14,100 cells/m3 preoperatively) as well as acute hypoxemic respiratory failure with a large left pleural effusion. Postprocedural computed tomography with contrast demonstrated a new large subcapsular splenic hematoma in communication with a new subdiaphragmatic fluid collection. Due to suspicion of endoscopic procedural complication, he underwent open laparotomy which revealed grade 4 splenic laceration, septic splenic hematoma, and a subdiaphragmatic abscess. Conclusions While endoscopic drainage of pancreatic pseudocyst was technically successful, this case demonstrates complications from mass effect of a large pancreatic pseudocyst which putatively tore the splenorenal ligament, leading to excessive separation of the left kidney and spleen. If anatomic disruptions caused by mass effect from a pancreatic pseudocyst are recognized through preprocedural abdominal imaging, such cases may be considered for early open repair versus cystogastrostomy.

Background: The spleen is the most frequently injured organ in abdominal trauma. The aim of this study was to evaluate the pattern and management outcome of splenic injury in children in a tertiary hospital. Methods: This was a retrospective study of children treated for splenic trauma at the Pediatric Surgery Unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. The medical records of the patients over a 10-year period were evaluated. Results: There were 61 cases of splenic trauma of which 72.1% were male. Their ages ranged from 4 to 14 years with a median of 10 years. Road traffic accident and fracture were the most common mechanism of injury and associated injury respectively. The majority had grade III splenic injury and non-operative management was the predominant modality of treatment. Operative procedures included splenectomy and splenorrhaphy. Mortality occurred in two (3.3%) patients. Conclusions: Splenic injury can be associated with significant morbidity and mortality. Road traffic accidents are a common cause of splenic injury and non-operative management is an effective modality of treatment.

Amaç: Künt karın travmasına bağlı solid organ yaralanması olan hastalarda nonoperatif tedavi (NOT) uygulaması güncel yaklaşımdır.NOT uygulanan travmalı hastaların takibinde halen birliktelik yoktur. Çalışmamızda literatürde NOT uygulama aşamasında bazı aydınlatılmayan alanlara ışık tutmayı amaçladık. Materyal-Metod: Çalışmamızda künt karın travmasına bağlı dalak yaralanması tespit edilen hastalar değerlendirildi. NOT başarılı olan hastalar ve NOT başarısız olup laparatomi yapılan hastalar tasnif edildi. Laparotomiye dönüş kriterlerimiz ise yeterli resusitasyona rağmen hemodinaminin instabil olması ve peritoneal irritasyon bulgularının varlığıydı.Yaralanma derecesine göre kendi içlerinde karşılaştırılarak analiz edildi.Gruplar karşılaştırılırken demografik bilgiler, travmanın oluş şekli,girişteki hemodinamik durum, BT’de yaralanmanın derecesi, yatış süresi boyunca kan ve kan ürünleri transfüzyonu gereksinimi, laparatomi gereksinimi, hastanede kalış süreleri, yoğun bakım ihtiyacı, ilk başvurudaki hemoglobin/hematokrit/lökosit sayısı değişimi ve oral beslenme zamanının tayini parametreleri kullanıldı. Bulgular: NOT uygulanan 72 vaka retrospektif olarak değerlendirildi. 10 hastada NOT uygulanırken başarısızlıkla sonuçlandı ve laparatomi uygulandı. Sonuç: Grade 3 ve üzeri yaralanmaların takibinde görüntüleme tetkikleri gerekebilir. NOT uygulanan hastalara hastaneye girişten itibaren yakın hemodinamik izlem, sık tekrarlayan fizik muayene ve etkin sıvı resusitasyonu yapılmalıdır. NOT uygulanan dalak travmalı hastalarda taburculuk sonrası erken dönemde yeniden kanama ve splenik abse gibi komplikasyonların olabileceği akılda tutulmalıdır.