[Intraoperative and postoperative complications of splenectomy]

Aspectos morfológicos e funcionais dos autoimplantes esplênicos em ratos tratados com oxigenio hiperbárico

OBJETIVO: Estudar aspectos morfológicos e funcionais dos autoimplantes esplênicos de ratos submetidos ou não à oxigenioterapia hiperbárica (OHB). MÉTODOS: Foram estudados em dois períodos distintos 105 ratos Wistar. No período mediato (n= 56) os animais foram avaliados até o 11º dia de pós-operatório, e no período tardio (n= 49), até o 70º dia. Em cada período os ratos foram distribuídos nos grupos: A- Simulação, B- Autoimplante esplênico, tratados com oxigênio hiperbárico ou não. Nos animais do Grupo A realizou-se apenas manipulação do baço. Nos animais do Grupo B realizou-se esplenectomia total e a seguir quatro fragmentos do baço foram implantados no grande omento. Em todos os animais foram dosados os lípides e imunoglobulinas e contadas as plaquetas e os corpúsculos de Howell-Jolly no pré-operatório e no 11º ou 70º dia de pós-operatório. O baço dos animais do Grupo A e os autoimplantes dos animais do Grupo B foram retirados e enviados para avaliação morfológica. RESULTADOS: No grupo B11nt houve aumento do colesterol total, LDL-colesterol, VLDL-colesterol e triglicérides. No grupo B70nt houve aumento do colesterol total e LDL-colesterol. Nos grupos tratados não houve alterações lipídicas. A IgM caiu nos grupos B e não alterou nos grupos A. Os corpúsculos de Howell - Jolly foram menos freqüentes nos grupos Bt que nos grupos Bnt. As plaquetas aumentaram nos grupos B11t e B11nt e não se alteraram nos demais grupos. A viabilidade microscópica dos grupos Bt foi melhor que a dos grupos Bnt. CONCLUSÃO: Os autoimplantes esplênicos dos animais tratados com OHB apresentaram melhor função e viabilidade do que os autoimplantes dos animais não tratados.

Growth of the lower spleen pole remaining after subtotal splenectomy in rats

PURPOSE

To determine whether the lower pole of the spleen grows after subtotal splenectomy following ligature of major spleen blood vessels.

METHODS

Thirty-nine Wistar rats (328.8 +/- 27.8 g) submitted to subtotal splenectomy with preservation of the lower splenic pole were divided into two groups: group 1 (control, n=20), immediate removal of the lower pole; group 2 (n=19), removal of the pole on postoperative day 80. The length, width and thickness of the pole were measured. In the control group, mean percent pole weight was calculated immediately after surgery in a direct and indirect manner. In the first case, the weight of the lower pole was divided by overall spleen weight; in the second case, pole weight was divided by the ideal weight of the spleen obtained by linear regression analysis. The results of the two calculations were compared. Macro- and microscopic examinations of the pole were performed.

RESULTS

In group 1, no significant difference in mean percent pole weight was observed between the direct and indirect method. In group 2, mean percent pole weight obtained by indirect calculation on day 80 was higher than in group 1 (p<0.001). In group 2, mean length, width and thickness of the pole remnant increased from the first to the 80th day (p<0.05). Histological analysis showed preserved tissue architecture and features compatible with cell hyperplasia in group 2.

CONCLUSION

The lower pole splenic remnant presented statistically significant growth up to postoperative day 80 after subtotal splenectomy, even after ligature of the major spleen vessels. Light microscopy revealed changes compatible with cell hyperplasia.

Pediatric Splenic Injury: Nonoperative Management First!

BACKGROUND AND PURPOSE

In the past splenectomy was the standard procedure for traumatic blunt splenic injury, when bleeding of the spleen occurred. Since the spleen performs important immunological functions the advantage of a spleen-saving approach is preservation of immunological functions. Especially in the pediatric population splenic preservation is an important objective. Spleen-saving treatment, in particular selective nonoperative management, has gained ground in the past 20 years. An 18-year retrospective review was performed to evaluate our cumulative experience with nonoperative management.

ENDPOINTS

hemodynamical instability and splenectomy.

METHODS

Forty-six patients were identified. Demographics, methods of management, mechanism of injury, injury grade, associated injuries, hemodynamical parameters, bloodtransfusion, complications, ICU and hospital stay were documented and analyzed to determine statistical significance between modes of management.

RESULTS

Initially, 34 patients were managed nonoperatively, while 12 patients underwent laparotomy - with 7 (58.3% of the operative group) of these having splenectomy performed. Three patients (out of 34) failed nonoperative management and required delayed splenorraphy or splenectomy, a 91.2% (3 out of 34 failed) success rate for intended nonoperative management versus 85.7% for intended splenorraphy (1 out of 7 failed). Thus, overall rates of 67.4% nonoperative management and 82.6% splenic conservation were achieved. Analysis of parameters between treatments showed significant differences between nonoperative management and splenorraphy for splenic injury grade II and IV.

CONCLUSION

We recommend based on our data on children with splenic injury grades II and IV that the standard treatment for children aged 0 to 18 years due to blunt abdominal trauma should be nonoperative management. However management of blunt splenic injury remains a clinical decision, for this reason does not preclude on CT-scan grade V for nonoperative management.