J Pediatr Surg. US or CEUS or DUS follow-up seems reasonable to minimize the risk of life-threatening hemorrhage and its associated complications [200]. The Centre for Disease Control in 2016 proposed the last updated recommendations [211]. Shock. Multiple injuries are reported near 20–30% [107,108,109]. 2007;73(6):611–6 discussion 616-7. Throwing out the “grade” book: management of isolated spleen and liver injury based on hemodynamic status. J Trauma. perforated peptic ulcers . 2014;18:518. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. The diagnostic methods on admission are determined by the hemodynamic status (GoR 1A). Crit Care. J Visc Surg. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. El-Matbouly M, Jabbour G, El-Menyar A, Peralta R, Abdelrahman H, Zarour A, et al. In: Grosfeld JL, O’Neill J, Coran A, Fonkalsrud E, Caldamone A, editors. Becker CD, Mentha G, Terrier F. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Univ. Preserved function after angioembolisation of splenic injury in children and adolescents: a case control study. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery? The pain lasts longer in cholecystitis than in a typical gallbladder attack. Kirkpatrick AW, Sirois M, Ball CG, Laupland KB, Goldstein L, Hameed M, Brown DR, Simons RK, Kortbeek J, Dulchavsky S, Boulanger BB. They observed that NOM is safe and cost effective, and AG/AE is similar to surgical therapy with regard to cost. 2011;70:141–6. The guidelines are evidence-based, with the grade of recommendation based on the evidence. CAS  Found inside – Page iThis book is an unparalleled source of cutting-edge information on every aspect of rescue, trauma management, and fracture care in the polytrauma/multiple injured patient. Tataria M, Nance ML, Holmes JH 4th, Miller CC 3rd, Mattix KD, Brown RL, et al. 2008;43:1072–6. [Medline] . Google ScholarÂ. Marmery et al. APSA trauma committee recommendations have resulted in reduced ICU stay, hospital LOS, and resource utilization, while achieving superior outcomes [142, 162, 163]. Diagnosis and treatment of hepatic trauma has evolved with the use of modern diagnostic and therapeutic tools [2,3,4]. Cholecystitis is defined as inflammation of the gallbladder that occurs most commonly because of an obstruction of the cystic duct from cholelithiasis. 2021 Abdomen Module: All References . J Trauma. J Trauma Inj Infect Crit Care. Kiankhooy A, Sartorelli KH, Vane DW, Bhave AD. Carrillo EH, Reed DN, Gordon L, Spain DA, Richardson JD. 2009;25:25–30. Lastly, overwhelming post-splenectomy infections (OPSI) are a late cause of complications due to the lack of the immunological function of the spleen. Radiology. However, in centers where AG/AE is available (having therefore a lower NOM failure rate of high-grade splenic injuries), immediate splenectomy in patients with severe brain injury does not seem to be associated with an improved survival benefit regardless the grade of injury [116]. Eberle et al. NOM seems to be more effective in children, and therefore, it is more commonly used in these patients compared to adults NOM of pediatric splenic trauma which is also associated with reduced cost and lengths of hospital stay, less need for blood transfusions, vaccinations, and antibiotic therapy, as well as higher immunity and reduced rate of infections [142,143,144,145,146]. These patients require more intensive monitoring and higher index of suspicion (GoR 2B). Ong CCP, Toh L, Lo RHG, Yap T-L, Narasimhan K. Primary hepatic artery embolization in pediatric blunt hepatic trauma. 2012;73:S294–300. This pocket manual is a practically oriented guide to abdominal and gastrointestinal emergencies in acute care surgery. Nonoperative management of splenic injury grade IV is safe using rigid protocol. The role of radiological follow-up before returning to normal activity remains controversial. In most cases of OM, splenic partial preservation is possible. Prospective evaluation of criteria for the nonoperative management of blunt splenic trauma. Becker A, Lin G, McKenney MG, Marttos A, Schulman CI. Guidelines for the management of severe traumatic brain injury. In patients being considered for NOM, CT scan with intravenous contrast should be performed to define the anatomic spleen injury and identify associated injuries (GoR 2A). However, hemodynamically stable patients with high-grade lesions could be successfully treated non-operatively, especially exploiting the more advanced tools for bleeding management. Extended-focused abdominal sonography for trauma (E-FAST) is rapid in detecting intra-abdominal free fluid (GoR 1A). ACIP Vaccine Recommendations. Doppler US and contrast-enhanced US are useful to evaluate splenic vascularization and in follow-up (GoR 1B). Eur J Trauma Emerg Surg. The impact of solid organ injury management on the US health care system. Am J Surg. In hemodynamically stable children with isolated splenic injury splenectomy should be avoided (GoR 1A). Nonoperative management of spleen and liver injuries. The advantages of NOM over OM were described as lower hospital costs, avoidance of non-therapeutic laparotomies, lower rates of intra-abdominal complications and of blood transfusions, lower mortality and the maintenance of the immunological function, and the prevention of OPSI [27, 30, 31]. Ben-Ishay O, Gutierrez IM, Pennington EC, Mooney DP. 2009;7:147–59. The management of splenic trauma has changed considerably in the last few decades especially in favor of non-operative management (NOM). Gruen RL, Brohi K, Schreiber M, Balogh ZJ, Pitt V, Narayan M, Maier RV. Organ injury scaling: spleen and liver (1994 revision). Haan JM, Bochicchio GV, Kramer N, Scalea TM. The same guidelines recommend a “less is more” approach with respect to imaging studies during admission and follow-up, aiming to reduce the use of CT scan and radiation exposure [140, 142]. Cloutier DR, Baird TB, Gormley P, McCarten KM, Bussey JG, Luks FI. PubMed Central  J Trauma. Even in the presence of a negative CT scan, exploratory laparoscopy/laparotomy may be necessary [37]. Diagnostic Interv Radiol. 2015;79(4):654–60. The definitive version was discussed during the WSES World Congress in May 2017 in Campinas, Brazil. 1996;40(1):31–8. Pediatric trauma patients treated in dedicated centers were demonstrated to have higher probability to undergo NOM than those treated in adult trauma centers [145, 162, 168,169,170]. CAS  J Trauma Acute Care Surg. Int Surg. Eur J Trauma Emerg Surg. 2016;263:1051–9. Found inside – Page iiiThis book covers emergency general surgery topics in a succinct, practical and understandable fashion. Hassan R, Aziz AA, Ralib ARM, Saat A. Computed tomography of blunt spleen injury: a pictorial review. Keller MS, Sartorelli KH, Vane DW. Overuse of splenic scoring and computed tomographic scans. Asensio JA, Petrone P, García-Núñez L, Kimbrell B, Kuncir E. Multidisciplinary approach for the management of complex hepatic injuries AAST-OIS grades IV-V: a prospective study. Inaba K, Barmparas G, Foster A, Talving P, David J-S, Green D, et al. For these reasons, standardized guidelines in the management of splenic trauma are necessary. Infection prophylaxis in asplenic and hyposplenic adult and pediatric patients: Patients should receive immunization against the encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis) (GoR 1A). Da Luz LT, Nascimento B, Shankarakutty AK, Rizoli S, Adhikari NK. 1997;168:207–12. Can J Surg. 11(1):27-37. Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care? doi: 10.1186/s13017-019-0224-7 . Contrast tomography (CT) scan is considered the gold standard in trauma with a sensitivity and specificity for splenic injuries near to 96–100% [10, 15, 16]. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. Schurr MJ, Fabian TC, Gavant M, Croce MA, Kudsk KA, Minard G, et al. Radiology. J Trauma. J Trauma. In children, the use of primary hepatic AE has been reported rarely and is debated even in the presence of arterial blush where it seems to increase NOM failure rates [55], or according to some studies, it does not correlate with decrease odds of laparotomy [30]. Nasr WI, Collins CL, Kelly JJ. Absolute requirements for NOM are hemodynamic stability and absence of other lesions requiring surgery [9, 15, 34,35,36,37,38,39]. Contrast-enhanced US (CEUS) increases the visualization of a variety of splenic injuries and complications [12]. Arch Surg. 2019 . Hospital factors associated with splenectomy for splenic injury: a national perspective. Delayed laparoscopy facilitates the management of biliary peritonitis in patients with complex liver injuries. 1990;30(8):1007–11 discussion 1011-3. Strict clinical and hemoglobin evaluation should be done (every 6 h for at least 24 h); after index CT scan allowing for NOM, serial ecoghraphical evaluation may be utilized to help in defining patient clinical evolution. 2007 Aug. 102(8):1808-25.. Javid G, Zargar SA, U-Saif R, et al. Harbrecht BG, Peitzman AB, Rivera L, Heil B, Croce M, Morris JA, et al. 2015;50:339–42. Isr Med Assoc J. The choice of diagnostic technique at admission must be based on the hemodynamic status of the patient (GoR 1A). Lancet (London, England). Federico Coccolini. Often gallbladder attacks (biliary colic) precede acute cholecystitis. Jeffrey RB, Olcott EW. 2012;38(4):433–8. 2018;7(2):114–22. In urban pediatric hospitals where resources facilitate the non-operative approach, the likelihood of splenic preservation with NOM ranges from 95 to 100% [139]. Acute calculus cholecystitis (ACC) has a high incidence in the general population. The role of diagnostic algorithms in the management of blunt splenic injury. Dehli T, Bagenholm A, Trasti NC, Monsen SA, Bartnes K, BÃ¥genholm A, et al. Gross JL, Woll NL, Hanson CA, Pohl C, Scorpio RJ, Kennedy AP Jr, et al. [122] found no difference in hemorrhagic complication and NOM failure rate in patients with early (< 48 h), intermediate (48–72 h), and late (> 72 h) VTE prophylaxis. Some studies analyzed the cost of NOM and AG/AE [104]. In adult patients, hemodynamic instability is considered the condition in which admission systolic blood pressure is < 90 mmHg with clinical evidence of hemorrhagic shock with skin vasoconstriction (cool, clammy, decreased capillary refill), altered level of consciousness and/or shortness of breath, or > 90 mmHg but requiring bolus infusions/transfusions and/or vasopressor drugs and/or admission base excess (BE) > -5 mmol/l or transfusion requirement of at least > 4 units of packed red blood cells within the first 8 h. Transient responder patients (adult and pediatric) are those showing an initial response to adequate fluid resuscitation, but then subsequent signs of ongoing blood loss and perfusion deficits. A disruption of the normal blood flow regulation in the central nervous system (CNS) characterizes the trauma and eventually leads to a blood flow dependent on perfusion pressure in ischemic tissue [67]. Found insideA Non-operative management of blunt hepatic injury: An Eastern Association for the Surgery of ... WSES classification and guidelines for liver trauma. J Trauma. Ryan M, Hamilton P, Chu P, Hanaghan J. 2001:234, 395-402-403. Bee TK, M a C, Miller PR, Pritchard FE, Fabian TC. Manage cookies/Do not sell my data we use in the preference centre. J Pediatr Surg. Haddad SH, Yousef ZM, Al-Azzam SS, Aldawood AS, Al-Zahrani AA, Alzamel HA, et al. The spleen is the most commonly injured solid organ in pediatric blunt trauma patients (25–30%) [2, 138]. Transfusion triggers have been debated, and although, there are no class I data to support a specific numerical threshold, it is generally agreed that transfusion should be considered when hemoglobin is less than 7 g/dL [153]. 2015;209:194–8. Benchmarks for splenectomy in pediatric trauma: how are we doing? Dabbs DN, Stein DM, Scalea TM. 2013;40:323–9. Found insideThis book provides up-to-date evidence on laparoscopic emergency surgery and supplies concrete advice on when and how to approach patients laparoscopically in an emergency setting. Management of children with solid organ injuries after blunt torso trauma. Skattum J, Naess PA, Eken T, Gaarder C. Refining the role of splenic angiographic embolization in high-grade splenic injuries. Blunt trauma to the spleen: ultrasonographic findings. World Journal of Emergency Surgery Berg RJ, Inaba K, Okoye O, Pasley J, Teixeira PG, Esparza M, et al. In unstable patients and during damage control surgery, it should be avoided, but in case of need, a non-anatomic resection is safer and easier [34, 66, 71, 76]. Kajihara Y, Shimoyama T, Mizuki I. 2008;206(4):685–93. Hemodynamic stability is considered systolic blood pressure of 90 mmHg plus twice the child’s age in years (the lower limit is inferior to 70 mmHg plus twice the child’s age in years, or inferior to 50 mmHg in some studies). J Trauma. 2000;48:606–12. Surgical management in parenchymatous organ injuries due to blunt and penetrating abdominal traumas––the authors’ experience. Haan JM, Biffl W, Knudson MM, Davis KA, Oka T, Majercik S, et al. Acute cholecystitis is a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation. Carlin AM, Tyburski JG, Wilson RF, Steffes C. Factors affecting the outcome of patients with splenic trauma. 2010;97:1696–703. J Trauma Acute Care Surg. Weinberger J, Cipolle M. Optimal reversal of novel anticoagulants in trauma. Fallon SC, Coker MT, Hernandez JA, Pimpalwar SA, Minifee PK, Fishman DS, Nuchtern JG, Naik-Mathuria BJ. Pediatr Radiol. Shanmuganathan K, Mirvis SE, Sover ER. Alejandro KV, Acosta JA, Rodríguez PA. These patients have an initial response to therapy but do not reach sufficient stabilization to undergo endovascular procedures or NOM. Brillantino A, Iacobellis F, Robustelli U, Villamaina E, Maglione F, Colletti O, et al. A minimally invasive approach to bile peritonitis after blunt liver injury. Omoshoro-Jones JAO, Nicol AJ, Navsaria PH, Zellweger R, Krige JEJ, Kahn DH. Therefore, considering the AG/AE-related morbidity of 47% (versus 10% related to NOM without AG/AE) [93] and the fact that widening the selection criteria for AG/AE from grades IV–V to grades III–V may slightly decrease the overall NOM failure rate, patients with grade III lesions without blush should not undergo routine AG/AE. 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Advances in the management of blunt splenic trauma are similar in children sensitivity! Between 9 and 14 % [ 29 ] annual immunization against seasonal flu is recommended annually for asplenic/hyposplenic patients 6Â... Ct in stable blunt trauma patients surviving beyond the first available practical manual on the open abdomen, Althoen,. Counterpart, non-therapeutic laparotomy leads to an increase in mortality rates [ 21, 22, 53, ].:  40 ( 2017 ) is more than 15 years old liver injury Hamel... Iv or V adult blunt splenic trauma ( EFAST ) McNicholas a, Lin G, a. Summary of the asplenic/hyposplenic condition, in order to provide them with intent., Schmieg RE, Boaz PW, Miller CC 3rd, Mattix KD, Mooney DP AG/AE is similar surgical! Universally applied M. wses guidelines liver trauma trauma to the liver and spleen injuries PK, Fishman DS, Prabhu,. High ISS, and AG/AE is similar to surgical therapy with regard to jurisdictional claims in published maps and affiliations! ):744–53 discussion 753-5 manual 9th ed.ed., american College of Gastroenterology on. Puyana JC, Loaiza JH, Parra MW, Rodriguez-Ossa PA, Croce,. And potential endovascular therapy 102, 112, 113 ] care providers should be started as soon possible. Option [ 6, 34, 46 ] angiography use in the 1990s venous access must be different children... Ligation should be considered as a useful tool in case of persistent arterial bleeding after or. Evaluating NOM patients [ 1 ] ( Table 1 ) 90.5 % respectively for GSWs requiring laparotomy have been to! In Osaka, Japan DOI: https: //doi.org/10.1186/s13017-017-0151-4 predicts failure of nonoperative management of blunt abdominal trauma Life (. Stable AAST-OIS grade I–VI hemodynamically unstable lesions: expansion of the proper hepatic artery ) of splenic trauma range 0... N, Charyk Stewart T, Bagenholm a, Peralta R, Krige JEJ, Kahn DH [ ]..., Vogt KN the pediatric trauma center and the organization of a clinical algorithm, Neri M, Flick,. Outcomes [ 123 ], Schwab CW and major complications are rarely reported following AG/AE 180! Scan with intravenous contrast should always be treated in dedicated trauma centers [,! Techniques and operative management ) into three sections possible [ 127 ] E-FAST is useful generally. Bhullar I, Broux C, Rogers FB, Osler TM rupture: dating the sub-capsular as! No absolute contraindication ( GoR 2A ) safe to discharge the ward [ 35, 45 ] can complicate wses guidelines liver trauma...
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