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Splenic Injury

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Prospective trial of angiography and embolization for all grade III to V blunt splenic injuries: nonoperative management success rate is significantly improved.
Miller PR, Chang MC, Hoth JJ, Mowery NT, Hildreth AN, Martin RS, Holmes JH, Meredith JW, Requarth JA.
J Am Coll Surg. 2014 Apr;218(4):644-8.

Rationale for inclusion: Implementation of a protocol utilizing angiography and embolization of all grade III, IV, and V splenic injuries decreased failure rates of nonoperative management strategies and is recommended routinely for these injuries in this manuscript.

Citations - 40 (as of July 2017)

Splenic embolization revisited: a multicenter review.
Haan JM, Biffl W, Knudson MM, Davis KA, Oka T, Majercik S, Dicker R, Marder S, Scalea TM; Western Trauma Association Multi-Institutional Trials Committee.
J Trauma. 2004 Mar;56(3):542-7.

Rationale for inclusion: This study from the Western Trauma Association began to investigate the complication rate following splenic embolization, citing bleeding, abscesses requiring splenectomy, and arterial injury.

Citations - 272 (as of July 2017)

Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma.
Peitzman AB, Heil B, Rivera L, Federle MB, Harbrecht BG, Clancy KD, Croce M, Enderson BL, Morris JA, Shatz D, Meredith JW, Ochoa JB, Fakhry SM, Cushman JG, Minei JP, McCarthy M, Luchette FA, Townsend R, Tinkoff G, Block EF, Ross S, Frykberg ER, Bell RM, Davis F 3rd, Weireter L, Shapiro MB.
J Trauma. 2000 Aug;49(2):177-87; discussion 187-9.

Rationale for inclusion: This multi-center EAST national study identified factors contributing to failure of nonoperative management of blunt splenic injury, utilizing 1488 patients from 27 trauma centers.  

Citations - 394 (as of July 2017)

Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms.
Davis KA, Fabian TC, Croce MA, Gavant ML, Flick PA, Minard G, Kudsk KA, Pritchard FE.
J Trauma. 1998 Jun;44(6):1008-13; discussion 1013-5.

Rationale for inclusion: This study introduced the concept that surveillance for and embolization of splenic artery pseudoaneurysms reliably improves the success of nonoperative management of splenic injuries, and should be performed in patients with initial evidence of contrast extravasation on CT imaging.   

Citations - 302 (as of July 2017)

Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis.
Sclafani SJ, Shaftan GW, Scalea TM, Patterson LA, Kohl L, Kantor A, Herskowitz MM, Hoffer EK, Henry S, Dresner LS, et al.
J Trauma. 1995 Nov;39(5):818-25; discussion 826-7.

Rationale for inclusion: Using 172 patients with blunt splenic injury, this series described the use of angiography to determine the potential success of nonoperative management, concluding the lack of contrast extravasation reliably predicts those patients who can be managed non-operatively.  In addition, this study described proximal coil embolization as a means to obtain hemostasis in patients with active extravasation to minimize need for operative intervention.

Citations - 304 (as of July 2017)

Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management.
Schurr MJ, Fabian TC, Gavant M, Croce MA, Kudsk KA, Minard G, Woodman G, Pritchard FE.
J Trauma. 1995 Sep;39(3):507-12; discussion 512-3.

Rationale for inclusion: This retrospective review identified that the presence of a contrast blush on initial CT imaging is associated with failure of nonoperative management of splenic lacerations.

Citations - 244 (as of July 2017)

Severe late postsplenectomy infection.
Cullingford GL, Watkins DN, Watts AD, Mallon DF.
Br J Surg. 1991 Jun;78(6):716-21.

Rationale for inclusion: This series described a very low rate of postsplenectomy infection (0.21 per 100 person years exposure)  and much lower rates of overwhelming postsplenectomy infection following splenectomy.  

Citations - 254 (as of July 2017)

The born-again spleen. Return of splenic function after splenectomy for trauma.
Pearson HA, Johnston D, Smith KA, Touloukian RJ.
N Engl J Med. 1978 Jun 22;298(25):1389-92.

Rationale for inclusion: This study found a more significant frequency of splenosis with retained splenic activity following traumatic splenectomy than previously suspected, contributing to overall low rates of post-splenectomy sepsis and infectious complications.

Citations - 378 (as of July 2017)

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