Ultraselective angioembolisation of splenic artery for atraumatic spleen rupture in a patient of systemic lupus erythematosus

A systemic lupus erythematosus (SLE) patient in her mid-30s presented with spontaneous splenic haematoma and rupture. She rapidly deteriorated despite packed red cells and fresh frozen plasma transfusions. She underwent emergent ultraselective angioembolisation of the splenic artery and got stabilised. Spontaneous or atraumatic splenic rupture is rare in SLE and splenic artery embolisation may be life-saving.

Two Cases of Minor Blunt Splenic Injury Accompanied with Unexpected Fatal Delayed Splenic Rupture

Contrast blush (CB) is an area with a density higher than the organ parenchyma in the arterial phase of contrast-enhanced computed tomography (CT). CB may be a sign of contrast medium extravasation, pseudoaneurysm, arteriovenous fistula, or other conditions; however, the indications for treatment remain unclear. Nevertheless, CB could be used to indicate a fatal scenario, such as delayed splenic rupture. Here, we present two multiple-injury cases of fatal delayed splenic rupture following the nonoperative management of a minor splenic injury. In both cases, despite morphological CT findings being minor on admission, CB was observed, and both patients could not rest owing to factors such as older age, a head injury, and drunkenness. Furthermore, in the CB case that indicated pseudoaneurysm, delayed splenic rupture occurred much earlier after the injury compared to the other case without the possibility of pseudoaneurysm. In conclusion, we recommend transcatheter arterial embolization be urgently performed in a case wherein the presence of a pseudoaneurysm is highly probable and factors such as multiple injuries and inability to rest are involved.

Navigating the Management of an F-16 Pilot Following Spontaneous Splenic Rupture

BACKGROUND: Little consensus exists on the best practices for post-acute care of patients who suffer splenic injury but retain functional splenic tissue. Moreover, no published guidance or case reports exist for managing pilots in this demographic, making the flight surgeon's task particularly difficulty as he/she attempts to apply the best available evidence for a patient population exposed to unique occupational hazards.CASE REPORT: We describe the case of an F-16 pilot who suffered a spontaneous splenic rupture due to infectious mononucleosis and required splenic artery embolization for hemodynamic stabilization. Despite the salvage of a significant portion of his spleen, the pilot was managed as an asplenic patient due to concern that: 1) splenic artery embolization compromised the function of his spleen; and 2) his status as a military aviator placed him at increased risk of infection due to frequent travel. He received appropriate vaccinations for an asplenic patient, fever precautions, and amoxicillin-clavulanic acid for immediate use if he developed fever. After discussion with the Aeromedical Consult Service, who felt the aviator had minimal risk of a poor outcome, he was returned to flying status. Since returning to flying status he has logged over 15 h of flight time, routinely experiencing 8-9 +G_z without difficulty.DISCUSSION: This case provides a successful approach to the management of pilots of high-performance aircraft who suffer splenic injury but retain functional splenic tissue, and provides precedent for safely returning these patients to flying status following recovery.Tanael M, Saul S. Navigating the management of an F-16 pilot following spontaneous splenic rupture. Aerosp Med Hum Perform. 2019; 90(12):1061-1063.

[Not Available]

We report the case of a 29-year-old patient who presented in the emergency room with severe abdominal pain. After initially inconspicuous medical history and laboratory evaluation, repeated focused history taking led to the correct diagnosis: a paintball projectile had left its mark. The patient had suffered a third-degree rupture of the spleen with delayed manifestation two weeks after the trauma. He could be successfully managed with an organ-preserving non-operative approach.

[Complications in the conservative managemennt of splenic rupture]

INTRODUCTION

Management of splenic rupture in haemodynamically stable children is non-surgical treatment. However, complications can occur during follow-up. Objective: to study the frequency, evolution and treatment of complications of conservative treatment of splenic rupture. Secondary objective: to evaluate the results of the American Pediatric Surgical Association (APSA) clinical guideline in conservative treatment.

MATERIAL AND METHODS

Retrospective study of patients with abdominal trauma between 2010-2016. We included children under 15 years of age with splenic injury after blunt abdominal trauma. Demographic variables, mechanism and degree of injury of American Association for the Surgery of Trauma were studied in the sample. The complications, the time of onset and their treatment were analyzed. The treatment was based on the recommendations of the APSA with the exception of ultrasound follow-up. In case of complications and according to the clinical and characteristics, embolization was indicated.

RESULTS

Twenty-eight patients were attended, 21 males (75%). The median age was 8.35 years (6.28-11.35). Seven patients (25%) presented complications: two arteriovenous fistula (AVF), three pseudo-aneurysms and two hemorrhages. The median time to diagnosis of complications was 5.67 days (P25 4- P75 5.75). Embolization was performed in two patients with pseudo-aneurysm. Another patient underwent emergency splenectomy for rebleeding. The rest of the complications resolved spontaneously.

CONCLUSIONS

In splenic rupture, unlike APSA, ultrasound monitoring is useful to rule out early complications.

Ten-year experience of splenic trauma in New Zealand: the rise of non-operative management

AIM

The aim of this study was to describe the demographics, mechanisms of injury, management and outcomes in patients who suffered splenic trauma in Christchurch, New Zealand.

METHODS

A retrospective study included all splenic injury patients admitted to Christchurch Public Hospital between January 2005 and August 2015.

RESULTS

A total of 238 patients were included, with a median age of 26 years (4-88.7). Of these, 235 patients had blunt injuries. Eighty-nine had high-grade injuries. Yearly admissions of splenic trauma patients have gradually increased. A total of 173 (72.7%) patients were managed with observation; 28 patients (11.8%) had radiological intervention and 37 patients (15.5%) had splenectomy. Patients who died were significantly more likely to be older (median, 46.5 vs 25.2 years, p=0.04) and to have been admitted to ICU (100% vs 32%, p=<0.001).

CONCLUSION

Splenic injuries have shown a steady increase in the last decade. Splenectomy rates have decreased in favour of non-operative techniques. Radiological intervention with splenic artery embolisation was successful in all selected patients with high-grade injuries.

A Lower Gastrointestinal Bleeding Due to a Post-Traumatic Splenosis: "Wait and See" Represents a Feasible Attitude: A Case Report

Splenosis represents a benign condition due to an ectopic localization of splenic tissue caused by pathologic or traumatic spleen rupture. Generally, it is asymptomatic and incidentally diagnosed during imaging performed for other reasons. Occult gastrointestinal bleeding due to an extraperitoneal localization is a rare occurrence. Differential diagnosis may be very hard and includes benign and malignant neoplasms.We describe the case of a 68-year-old Caucasian man that was admitted for an increasing lower gastrointestinal bleeding associated to a vague abdominal pain.He was assessed by means of laboratory tests, as well as by endoscopic and radiological examinations, and successfully treated with an exclusive medical approach.The patient was discharged on the ninth day and currently he is doing well.This case shows that wait and see could prove a feasible attitude for the management of clinically stable patients.

Postpartum splenic rupture: a possible iatrogenic event, but finalized with successful conservation of the spleen

The authors present the case of a postpartum splenic rupture induced probably by iatrogenic injury (recent vaginal delivery with a prolonged expulsion with uterine fundus compression) including the left hypochondria region costal grid. The case was solved with splenic preservation and achieving hemostasis only by local plugging and Gelaspon. The case raised also other problems regarding the etiology of splenic rupture, in establishing a causal relationship between a intrapartum splenic injury, and the three episodes of inferior genital tract hemorrhaging, in establishing the cause of the infectious syndrome from the 24h postpartum day, (parietal infection or splenic abscess requiring splenectomy).

Management of Traumatic Splenic Rupture in Adults: A Single Center's Experience in Mainland China

BACKGROUND/AIMS

We evaluated the effectiveness of various therapies to treat the traumatic splenic rupture by using data from our single center.

METHODOLOGY

From July 2008 to Jan 2014, 125 patients who were diagnosis spleen rupture without other organ injury were included into our present study. We divided these patients into two groups according to the managements of the splenic rupture: the operative management (OM) group (48 patients) and the non-operative management (NOM) group (77 patients). We compared the baseline characteristics and long-term outcomes of two groups. the OM group was divided into three sub-groups according to the different operative methods: the total splenectomy group, partial splenectomy group and radiofrequency ablation (RFA) group.

RESULTS

Splenic injuries were most commonly observed in abdominal trauma: traffic accidents (49 cases), fall from height (36 cases), strike (22 cases), assaults (11 cases), and sports (7 cases). Of the patients included in our study, 48 patients accepted OM, and 77 patients accepted NOM. The baseline characteristics, including age, gender, BMI, and underlying diseases, were comparable between the two groups. However, the OM group patients exhibited more severe splenic rupture according to the AAST grade (P = 0.000). The three subgroups in the OM group (total splenectomies group (26 cases), partial splenectomy (12 patients), RFA-assisted spleen-preserving surgery (10 patients) exhibited no significant differences with respect to intraoperative data or postoperative recovery. The length of hospital stay in the NOM group was significantly longer than that in the OM group (6.8 ± 1.4 VS 3.4 ± 0.8, P = 0.000), but the OM and NOM patients reported comparable quality of life according to the SF-36 scale.

CONCLUSION

In conclusion, the outcomes of operative management for splenic rupture were comparable, and the OM and the NOM patients exhibited a similar quality of life after splenic rupture, although longer hospital stays were observed in the NOM group.

[Spontaneous rupture of the spleen after infectious mononucleosis]

Non-traumatic rupture of the spleen (NRS) is a rare but serious complication to infectious mononucleosis (IM) and it is important to have in mind, when patients have IM. Although splenectomy has been advocated as the appropriate treatment for this problem, the trend goes towards conservative treatment of the haemodynamically stable patients, but because of its rarity no clear guidelines have been suggested. We present a case of a 18-year-old boy with IM who had NRS with subcapsular haematoma and was treated conservatively. He recovered completely.

[Rupture of the spleen following Caesarean section]

A case of rupture of the spleen after Caesarean section is presented. Rupture of the spleen is a rare complication of pregnancy. The aetiology of splenic rupture is discussed. It is important to keep this rare condition in mind. Fast intervention limits the effects of this potentially lethal condition.

[Nonoperative management of spontaneous splenic rupture in infectious mononucleosis]

Spontaneous splenic rupture is a rare complication of infectious mononucleosis observed in 0.1-0.5% of patients with this condition. Mandatory mode of management in hemodynamically stable patients is nonoperative treatment. We report the case of a 19-year old man with splenic rupture, during the course of serological and hematological confirmed infectious mononucleosis, with no history of trauma. Parenchymal and subcapsular splenic hematomas and presence of blood in vesico-rectal recess was demonstrated. Circulatory and respiratory findings and blood cell count were stable. Nonoperative management was instituted which comprised monitoring of valid vital signs, serial USG and tomography scans and vital activity limitation. Imaging radiological investigations demonstrated disappearance of observed abnormalities on post admission day 20. The patient was discharged from the hospital in good general condition.

CONCLUSION

Nonoperative management can be a safe alternative to splenectomy in hemodynamically stable patient with spontaneous rupture of the spleen.

Successful conservative treatment of spontaneous splenic rupture secondary to Babesiosis: a case report and literature review

Babesiosis is caused by a protozoan parasite of the genus Babesia. In the United States, the usual infective organism Babesia microti, is most commonly transmitted through the bite of an infected Ixodestick. While the majority of patients exhibit sub-clinical signs and symptoms, significant illness can result. Spontaneous splenic rupture is a life-threatening complication of some viral and protozoan infections. We present a case of Babesiosis with spontaneous splenic rupture in which conservative management with blood transfusions and hospital-based care were successful, and the patient was spared splenectomy. To our knowledge, this is the first reported case treated without splenectomy. Our successful experience suggests conservative management may be appropriate for some patients.

Spontaneous rupture of the spleen: a rare complication in a patient with lupus nephritis on hemodialysis

Rupture of the spleen is a life threatening condition. We report a 40-year-old fe-male patient, a known case of lupus nephritis receiving hemodialysis, who developed spontaneous rupture of the spleen during the course of her illness. The patient was managed conservatively with gradual regression of hematoma without further complications.

[Splenic angioembolization--a safe, efficient and rational approach]

The authors present a case of postraumatic splenic rupture grade III (AAST-OIS), with injury severity score 10, revised trauma score 7841 managed nonoperatively, by angioembolization, with successful outcome. The indications and different types of splenic angioembolization in trauma are discussed, together with the role of this procedure in increasing the success rate of nonoperative management. Up to our knowledge, this is the first reported case of therapeutic splenic angioembolization in the Romanian medical literature.

[Indications for non-surgical management of traumatic splenic rupture: report of 36 cases]

OBJECTIVE

To investigate the indications for non-surgical management of traumatic splenic rupture.

METHODS

From Jan. 2002 to Jan. 2008, 36 patients with traumatic splenic rupture underwent non-surgical management in the First Affiliated Hospital of Jinan University.

RESULTS

Of the 36 cases, 32 were successfully managed without surgical interventions, and 4 converted to open surgery. No death occurred in these patients, nor was delayed splenic rupture identified 1 to 5 years after the treatment.

CONCLUSION

Hemodynamically index is an important reference to select the patients, and the degree of splenic rupture, the patient's age and conditions of the hospital should be considered.

Spontaneous rupture of tuberculous spleen in a HIV seropositive patient on maintenance hemodialysis

Spontaneous rupture of the spleen usually occurs secondary to infection, hematological disorders or infiltrative lesions of the spleen. In patients with positive human immunodeficiency virus (HIV) antibodies and the acquired immunodeficiency syndrome (AIDS) who present with acute abdomen, splenic rupture should be considered as a possible cause and should additionally be investigated for co-infection with tuberculosis. Spontaneous rupture of spleen in asymptomatic patients requires a high index of suspicion for diagnosis. We herein report on a HIV-positive patient on maintenance hemodialysis, who presented with spontaneous rupture of a tuberculous spleen.

[A survival case of hepatocellular carcinoma with splenic metastasis: metachronous rupture at the liver primary and splenic metastatic lesion]

A 78-year-old man was referred to our hospital in March 2003 for rupture of hepatocellular carcinoma (HCC). Hemostasis was obtained by emergency angiography. In December 2004, metastasis to the right lung appeared and right lower lobectomy was carried out. In October 2005, a splenic metastatic lesion ruptured and hemostasis was obtained by emergency partial splenic embolization (PSE). Since viable remnants of the splenic tumor were suspected by CT, splenectomy was subsequently performed. He has been followed up in the outpatient clinic without recurrence. This is a markedly rare case of HCC in which, metachronous rupture primary and metastatic lesions, the patient was saved.

Nonoperative management of spontaneous splenic rupture in infectious mononucleosis: a case report and review of the literature

Spontaneous rupture of the spleen is a rare complication of infectious mononucleosis with no clear consensus on appropriate management. Although management of traumatic splenic rupture has largely moved to nonoperative treatment, splenectomy is still frequently used in dealing with rupture of the diseased spleen. Here we report the case of a 16-year-old boy with splenic rupture secondary to laboratory-confirmed infectious mononucleosis in the absence of trauma. Nonoperative management including ICU admission, serial computed tomography scans, and activity limitation was used successfully. Our experience, along with a review of the literature, leads us to conclude that splenic preservation can be a safe alternative to splenectomy in hemodynamically stable patients with spontaneous splenic rupture. This is of particular importance in the pediatric population, which is at higher risk for postsplenectomy sepsis.

Non-obstetrical acute abdomen during pregnancy

Acute abdomen in pregnancy remains one of the most challenging diagnostic and therapeutic dilemmas today. The incidence of acute abdomen during pregnancy is 1 in 500-635 pregnancies. Despite advancements in medical technology, preoperative diagnosis of acute abdominal conditions is still inaccurate. Laboratory parameters are not specific and often altered as a physiologic consequence of pregnancy. Use of laparoscopic procedures as diagnostic tools makes diagnosis of such conditions earlier, more accurate, and safer. Appendicitis is the most common cause of the acute abdomen during pregnancy, occurring with a usual frequency of 1 in 500-2000 pregnancies, which amounts to 25% of operative indications for non-obstetric surgery during pregnancy. Surgical treatment is indicated in most cases, as in nonpregnant women. Laparoscopic procedures in the treatment of acute abdomen in pregnancy proved safe and accurate, and in selected groups of patients are becoming the procedures of choice with a perspective for the widening of such indications with more frequent use and subsequent optimal results. Despite these advances, laparotomy still remains the procedure of choice in complicated and uncertain cases.

Nonoperative management of delayed splenic rupture in a patient with hemophilia B

Nonoperative management of splenic lacerations has become the standard of care in hemodynamically stable patients. The decision to manage a patient nonoperatively is much more difficult when the patient has a known bleeding disorder. There are a few case reports in the literature describing nonoperative management of splenic trauma in children with hemophilia A (factor VIII deficiency), but only one case report of a patient with hemophilia B (factor IX deficiency) and a splenic laceration successfully managed nonoperatively. We present the case of a 13-year-old boy who presented with a grade 4 splenic laceration, acute blood loss anemia, and hypotension that was managed nonoperatively.

Complications occurring during conservative management of splenic trauma in children

AIM

Conservative management of splenic rupture in haemodynamically stable children is now generally accepted. However, during follow-up, many complications can occur. The aim of this study was to describe the complications we observed and to propose a standardised follow-up adapted to them.

METHODS

Between March 1992 and December 2002 we managed 65 children (aged between 3 and 15 years old) with accidental splenic rupture. Follow-up and treatment consisted of a 10-day bed rest with sonogram and Doppler controls on the 5th and 10th day and subsequently every month until complete healing. Complications included secondary haemorrhage in 3 cases, cystic evolution in 5 cases, and pseudo-aneurysm in 2 cases. All were treated by renewed bed rest. Three of the cysts resolved spontaneously, the other two underwent cystic resection and epiploplasty by laparotomy (n = 1) or laparoscopy (n = 1) and both pseudo-aneurysms were selectively embolised. There were no splenectomies.

CONCLUSIONS

Complications essentially occurred in older children and were not related to gender, type of fracture, or extent of bleeding. Cystic evolution of the sub-capsular haematomas can appear up to 1 month after trauma. Peripheral pseudo-aneurysms which could be responsible for secondary haemorrhages were selectively embolised. We favour the use of the Doppler sonogram for follow-up until total recovery of these patients, even in low-grade traumas. Considering the number of complications encountered we do not believe the American evidence-based guidelines are suitable for our population.

Gastrointestinal complications of bariatric surgery: diagnosis and therapy

Severe or morbid obesity, with body mass indexes exceeding 35 to 40, are often refractory to all therapies other than surgery. The increasing number of patients undergoing bariatric surgery will result in increasing numbers of patients with gastrointestinal complications. The types of complications vary with type of surgery, whether restrictive, malabsorptive, or both, depending on what anatomical and physiologic changes occur postoperatively. One complication of bariatric surgery (gallstones) is due to weight loss after surgery, not the surgery itself. Based on previous meta-analyses, most of the top 10 complications from bariatric surgery are gastrointestinal: dumping, vitamin/mineral deficiencies, vomiting (and nausea), staple line failure, infection, stenosis (and bowel obstruction), ulceration, bleeding, splenic injury, and perioperative death. Two other gastrointestinal complications of bariatric surgery are indirect consequences of the surgery: bacterial overgrowth and diarrhea. Awareness of the types and frequency of gastrointestinal complications of bariatric surgery allows for timely diagnosis and appropriate therapy. As new surgical, and even endoscopic, procedures to treat obesity are developed, new gastrointestinal complications will need to be recognized.

Nonoperative management of spontaneous splenic rupture in infectious mononucleosis: the role for emerging diagnostic and treatment modalities

Infectious mononucleosis (IM) is a self-limiting lymphoproliferative disorder affecting teenagers and young adults. Splenomegaly is a common manifestation of IM and results in a compromised organ that may rarely rupture spontaneously, with significant morbidity and mortality. The IM spleen should be protected from even minor trauma. Although traditional management of spontaneous splenic rupture in IM has been splenectomy, the role of nonoperative management is evolving. The advent of endovascular interventional modalities has augmented the physician's armamentarium in managing these patients nonoperatively. We report a case of spontaneous splenic rupture in a patient with IM managed conservatively with the aid of splenic angiography. The option of arteriography, with or without embolization, should be considered in the management of all patients with spontaneous splenic rupture in the setting of IM.

Splenic rupture in a premature neonate

Splenic injuries are very rare in neonates. We report a case of splenic injury in a premature neonate, highlighting the importance of a high-index suspicion in early recognition of this rare but potentially fatal intra-abdominal injury. We also review the literature on possible aetiologies and mechanism of splenic injury, as well as its management. This is the first reported case of a very low-birth-weight neonate with splenic rupture who survived with intact neurology.

Spontaneous subcapsular splenic hematoma: a rare complication of pancreatitis

Subcapsular hematoma of the spleen is a rare complication of pancreatitis despite its close proximity to the pancreas. Pancreatic pseudocyst involving the tail of the pancreas may erode into the splenic hilum causing hilar vessel bleeding with subcapsular dissection and hematoma formation. The management of such complication is still controversial. It has been suggested that most of these complications spontaneously regress and therefore can be managed conservatively. A case of spontaneous splenic subcapsular hematoma resulting from pancreatitis was managed conservatively with a good outcome.

Splenic rupture and haemoperitoneum in a patient with non-compaction of the left ventricular myocardium

The anaesthetic and critical care management of blunt abdominal trauma in a patient previously diagnosed with non-compaction of the left ventricular myocardium (a rare autosomal dominant inherited disease) is reported. The management was influenced by the presence of an implanted automated internal defibrillator and treatment with anticoagulants because of the high frequency of severe arrhythmias and systemic embolism. The pathophysiology of ventricular non-compaction is reviewed briefly.

Is anything new in adult blunt splenic trauma?

Several decades ago, a shift occurred in the management of adult splenic injuries. Influenced by the experience in pediatric trauma patients, adult trauma surgeons began turning from mandatory operative treatment of all splenic injuries toward nonoperative management. Nonoperative treatment is now the most common method of management for patients with splenic injuries and is the most common method of splenic salvage. However, controversy exists about how to appropriately select patients for nonoperative treatment since bleeding from splenic injuries can incur significant morbidity and mortality. Recent refinements in the management of adult blunt splenic injuries will be reviewed.

[Diagnosis and treatment of traumatic splenic rupture in children: report of 70 cases]

OBJECTIVE

To evaluate the choice of treatment method for traumatic splenic rupture in children.

METHODS

A retrospective analysis of 70 children with traumatic splenic rupture was performed.

RESULTS

Of the 70 children, 10 were managed with non-surgical treatment and cured. In the 60 children receiving operations, 35 underwent partial splenectomy or prosthesis, 25 had total splenectomy, and the other 21 received autologous spleen transplantation. The follow-up study of 61 children lasting for 3 months to 5 years after operation did not reveal the occurrence of overwlrelmingpostsplenectomy infection.

CONCLUSION

The decision on adequate management of traumatic splenic rupture in children should be made on the basis of the patient's condition and severity of spleen injury, and autologous spleen transplantation can be safe and effective in children with splenectomy.

Assessment of nonoperative management of blunt spleen and liver trauma

An 8-year analysis of nonoperative management (NOM) of spleen and liver trauma was done in a level 1 trauma center. Spleen and liver trauma was diagnosed in 279 patients: 93 children (<18), 137 younger adults (18-54), and 49 older adults (> or = 55). Nineteen patients who failed resuscitations died within 0-60 minutes of arrival and were excluded from treatment analysis. Operative management (OM) was done in 39 (15%) and NOM in 221 (85%) patients with failure (NOMF) in 11 (5%). NOM and NOMF was 82 per cent and 5.6 per cent in spleen, 74 per cent and 14.3 per cent in combined spleen/liver, and 96 per cent and 1.5 per cent in liver trauma (P value <0.001). NOM was done in 99 per cent of children, 81 per cent of younger adults, and 68 per cent of older adults with 0 per cent, 8 per cent, and 10 per cent NOMF. Higher grades of splenic trauma and CT fluid had higher OM rate. NOM success rates were 93.8 per cent in grade 3 and 90.3 per cent in higher grades of spleen trauma. There was no NOMF in higher grades of liver trauma. CT fluid grade had no impact on NOMF. Female patients had higher mean injury severity score, age, and mortality compared to cohorts. NOM should be attempted in hemodynamically stable patients. Age over 55, higher grades of injury, and large hemoperitoneum were not predictors of failure of NOM.

Isolated blunt splenic injury: do we transfuse more in an attempt to operate less?

OBJECTIVE

To determine if blood transfusion requirements in patients with isolated blunt splenic injury (BSI) are greater if they are managed nonoperatively, we did a retrospective case study of patients with isolated BSI who were seen at a Canadian university teaching hospital over a 10-year period.

METHOD

Data such as number of units of packed erythrocytes transfused and mortality in the 75 patients with isolated BSI seen from 1992 to 2002 were separated into operative and nonoperative management groups.

RESULTS

In the operative management group (n = 10), patients received more transfused erythrocytes (3.0 v. 0.7 units), and a higher proportion of patients were transfused (80% v. 20%). There were no deaths in either group.

CONCLUSION

In the management of isolated BSI, initial nonoperative management does not increase patients' requirements for blood transfusion.