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Serna C, Serna JJ, Caicedo Y, Padilla N, Gallego LM, Salcedo A, Rodríguez-Holguín F, González-Hadad A, García A, Herrera MA, Parra MW, Ordoñez CA. Damage control surgery for splenic trauma: "preserve an organ - preserve a life". Colomb Med (Cali) 2021; 52:e4084794. [PMID: 34188324 PMCID: PMC8216056 DOI: 10.25100/cm.v52i2.4794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.
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Affiliation(s)
- Carlos Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - José Julián Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | | | - Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
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Giménez Francés C, Ruiz Marín M, López Morales P, Albarracín Marín-Blázquez A. In relation to "Response to 'Management of splenic injuries utilizing a multidisciplinary protocol in 110 consecutive patients at a level II hospital"'. Cir Esp 2020; 98:568-569. [PMID: 32762954 DOI: 10.1016/j.ciresp.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Clara Giménez Francés
- Cirujano, Servicio de Cirugía General, Hospital General Universitario Reina Sofía, Murcia, España.
| | - Miguel Ruiz Marín
- Cirujano, Servicio de Cirugía General, Hospital General Universitario Reina Sofía, Murcia, España; Profesor de Cirugía, Facultad de Medicina, Universidad Católica San Antonio, Murcia, España
| | - Pedro López Morales
- Cirujano, Servicio de Cirugía General, Hospital General Universitario Reina Sofía, Murcia, España
| | - Antonio Albarracín Marín-Blázquez
- Cirujano, Servicio de Cirugía General, Hospital General Universitario Reina Sofía, Murcia, España; Profesor de Cirugía, Facultad de Medicina, Universidad Católica San Antonio, Murcia, España; Jefe de Servicio, Responsable de la Cátedra de Cirugía, Facultad de Medicina, Universidad Católica San Antonio, Murcia, España
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Pérez Alonso AJ, Zurita Saavedra M, Gomez Sanchez J, Petrone P. Reply to «Response to management of splenic injuries utilizing a multidisciplinary protocol in 110 consecutive patients at a level ii hospital». Cir Esp 2020; 98:500-501. [PMID: 32600643 DOI: 10.1016/j.ciresp.2020.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Alejandro José Pérez Alonso
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático. Servicio de Cirugía General y del Aparato Digestivo. Hospital Virgen de las Nieves, Granada, España.
| | - Marisol Zurita Saavedra
- Unidad de Cirugía Coloproctológica. Servicio de Cirugía General y del Aparato Digestivo. Hospital Clínico San Cecilio, Granada, España
| | - Javier Gomez Sanchez
- Unidad de Cirugía Coloproctológica. Servicio de Cirugía General y del Aparato Digestivo. Hospital Clínico San Cecilio, Granada, España
| | - Patrizio Petrone
- Department of Surgery, NYU Langone Health-NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva York, Estados Unidos
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Marco CA, Gangidine M, Greene PJ, Taitano D, Holbrook MB, Ballester M. Delayed diagnosis of splenic injuries: A case series. Am J Emerg Med 2020; 38:243-246. [DOI: 10.1016/j.ajem.2019.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022] Open
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Zurita Saavedra M, Pérez Alonso A, Pérez Cabrera B, Haro García AM, Ruiz García VM, Mirón Pozo B, Petrone P. Management of Splenic Injuries Utilizing a Multidisciplinary Protocol in 110 Consecutive Patients at a Level II Hospital. Cir Esp 2019; 98:143-148. [PMID: 31739975 DOI: 10.1016/j.ciresp.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/19/2019] [Accepted: 08/31/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Non-operative treatment (NOM) of splenic trauma is the management of choice in hemodynamically stable patients. The aim of the present study was to assess the failure rate of NOM after implementation of a multidisciplinary protocol for splenic injuries compared to literature results. METHODS A retrospective study was performed over a 16-year period. Patient data and management of splenic trauma was recorded according to our hospital protocol: demographic data, blood pressure, respiratory rate, Glasgow Coma Scale(GCS), Revised Trauma Score(RTS), Injury Severity Score(ISS), injury grade according to the American Association for the Surgery of Trauma(AAST), failure of NOM, morbidity and mortality. RESULTS One hundred ten patients were included: 90(81.8%) men, 20(18.2%) women; mean age 37 years; 106(96.5%) cases were blunt and four(3.5%) penetrating by knife. The diagnosis was established by US/CT. AAST classification: 14(13%) grade I; 24(22%) grade II; 34(31%) grade III; 37(34%) grade IV. Emergency laparotomy was performed in 54 patients: 37 due to grade IV injuries, 17 due to hemodynamic instability. NOM was utilized in 56 patients, spleen-preserving surgery in 16, and splenectomy in 38. Ten patients had postoperative complications: seven in the splenectomy group, two in the spleen-preserving surgery group, and one in the NOM group. One patient died. Average hospital stay: 22.8 days- NOM 17.6 days, conservative surgery 29 days, splenectomy 22.4 days. CONCLUSIONS Although we continue with a high hospital stay, the literature reports support our results. The implementation of the protocol by consensus contributed to the change towards NOM.
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Affiliation(s)
| | - Alejandro Pérez Alonso
- Unidad de Cirugía HBP, Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario de Jaén, Jaén, España; Departamento de Cirugía y sus Especialidades, Facultad de Medicina, Universidad de Granada, Granada, España
| | | | | | - Víctor Manuel Ruiz García
- Unidad de Cirugía HBP, Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario de Jaén, Jaén, España; Departamento de Cirugía y sus Especialidades, Facultad de Medicina, Universidad de Granada, Granada, España
| | - Benito Mirón Pozo
- Servicio de Cirugía General, Hospital Universitario San Cecilio, Granada, España
| | - Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola (Nueva York), Estados Unidos.
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Ruscelli P, Gemini A, Rimini M, Santella S, Candelari R, Rosati M, Paci E, Marconi V, Renzi C, Commissari R, Cirocchi R, Santoro A, D’Andrea V, Parisi A. The role of grade of injury in non-operative management of blunt hepatic and splenic trauma: Case series from a multicenter experience. Medicine (Baltimore) 2019; 98:e16746. [PMID: 31464904 PMCID: PMC6736468 DOI: 10.1097/md.0000000000016746] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This retrospective study shows the results of a 2 years application of a clinical pathway concerning the indications to NOM based on the patient's hemodynamic answer instead of on the injury grade of the lesions.We conducted a retrospective study applied on a patient's cohort, admitted in "Azienda Ospedaliero-Universitaria Ospedali Riuniti of Ancona" and in the Digestive and Emergency Surgery Department of the Santa Maria of Terni hospital between September 2015 and December 2017, all affected by blunt abdominal trauma, involving liver, spleen or both of them managed conservatively. Patients were divided into 3 main groups according to their hemodynamic response to a fluid administration: stable (group A), transient responder (group B) and unstable (group C). Management of patients was performed according to specific institutional pathway, and only patients from category A and B were treated conservatively regardless of the injury grade of lesions.From October 2015 to December 2017, a total amount of 111 trauma patients were treated with NOM. Each patient underwent CT scan at his admission. No contrast pooling was found in 50 pts. (45.04%). Contrast pooling was found in 61 patients (54.95%). The NOM overall outcome resulted in success in 107 patients (96.4%). NOM was successful in 100% of cases of liver trauma patients and was successful in 94.7% of splenic trauma patients (72/76). NOM failure occurred in 4 patients (5.3%) treated for spleen injuries. All these patients received splenectomy: in 1 case to treat pseudoaneurysm, (AAST, American Association for the Surgery of Trauma, grade of injury II), in 2 cases because of re-bleeding (AAST grade of injury IV) and in the remaining case was necessary to stop monitoring spleen because the patient should undergo to orthopedic procedure to treat pelvis fracture (AAST grade of injury II).Non-operative management for blunt hepatic and splenic lesions in stable or stabilizable patients seems to be the choice of treatment regardless of the grade of lesions according to the AAST Organ Injury Scale.
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Affiliation(s)
- Paolo Ruscelli
- Emergency Surgery Unit, Torrette Hospital, Polytechnic University of Marche, Via Conca 71, Torrette, Ancona
| | - Alessandro Gemini
- Department of Digestive Surgery, St. Maria Hospital, Viale Tristano di Joannuccio, Terni
| | - Massimiliano Rimini
- Emergency Surgery Unit, Torrette Hospital, Polytechnic University of Marche, Via Conca 71, Torrette, Ancona
| | - Sergio Santella
- Emergency Surgery Unit, Torrette Hospital, Polytechnic University of Marche, Via Conca 71, Torrette, Ancona
| | - Roberto Candelari
- Emergency Surgery Unit, Torrette Hospital, Polytechnic University of Marche, Via Conca 71, Torrette, Ancona
| | - Marzia Rosati
- Emergency Surgery Unit, Torrette Hospital, Polytechnic University of Marche, Via Conca 71, Torrette, Ancona
| | - Enrico Paci
- Emergency Surgery Unit, Torrette Hospital, Polytechnic University of Marche, Via Conca 71, Torrette, Ancona
| | - Vittorio Marconi
- Emergency Surgery Unit, Torrette Hospital, Polytechnic University of Marche, Via Conca 71, Torrette, Ancona
| | - Claudio Renzi
- Department of Surgical Sciences, University of Perugia, Piazza dell’Università 1, Perugia
| | - Rita Commissari
- Department of Emergency, St. Maria Hospital, Viale Tristano di Joannuccio, Terni
| | - Roberto Cirocchi
- Department of Surgical Sciences, University of Perugia, Piazza dell’Università 1, Perugia
| | - Alberto Santoro
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, Italy
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, Italy
| | - Amilcare Parisi
- Department of Digestive Surgery, St. Maria Hospital, Viale Tristano di Joannuccio, Terni
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