Document Detail


Experience with selective operative and nonoperative treatment of splenic injuries in 193 patients.
MedLine Citation:
PMID:  2339919     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
During the past decade splenic salvage procedures rather than splenectomy have been considered the preferred treatment for traumatic splenic injuries. Splenic preservation has been most often accomplished by splenorrhaphy and more recently by a controversial nonoperative approach. This report delineates indications, contraindications, and results with splenectomy, splenorrhaphy, and nonoperative treatment based on an 11-year experience (1978 to 1989) in which 193 consecutive adult patients with splenic injuries were treated. One hundred sixty-seven patients (86.5%) underwent urgent operation. Of these, 111 (66%) were treated by splenorrhaphy or partial splenectomy and 56 (34%) were treated by splenectomy. During the last 4 years, 26 additional patients (13.5%) were managed without operation. Patients considered for nonoperative treatment were alert, hemodynamically stable with computed tomographic evidence of isolated grades I to III splenic injuries. Overall 24% of the injuries resulted from penetrating trauma, whereas 76% of the patients sustained blunt injuries. Complications were rare, with two patients in the splenorrhaphy group experiencing re-bleeding (1.8%) and one patient (4%) failing nonoperative treatment. The mortality rate for the entire group was 4%. This report documents that splenorrhaphy can safely be performed in 65% to 75% of splenic injuries. Splenectomy is indicated for more extensive injuries or when patients are hemodynamically unstable in the presence of life-threatening injuries. Nonoperative therapy can be accomplished safely in a small select group (15% to 20%), with a success rate of nearly 90% if strict criteria for selection are met.
Authors:
H L Pachter; F C Spencer; S R Hofstetter; H G Liang; J Hoballah; G F Coppa
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  211     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1990 May 
Date Detail:
Created Date:  1990-06-18     Completed Date:  1990-06-18     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  583-9; discussion 589-91     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, New York University Medical Center, NY 10016.
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MeSH Terms
Descriptor/Qualifier:
Adult
Evaluation Studies as Topic
Hematoma / surgery
Humans
Spleen / injuries*,  radiography,  surgery
Splenectomy
Splenic Diseases / surgery
Tomography, X-Ray Computed
Wounds, Nonpenetrating / surgery
Wounds, Penetrating / surgery
Comments/Corrections

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