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Abstract

Better understanding of the dual functionality of the spleen has led to a conservative approach to splenic trauma. With accurate assessment and vigilant clinical examination up to two thirds of splenic injuries can be managed expectantly; when surgery is unavoidable, splenic preserving techniques may be used to maintain function.

References

  • Brady RRW, Bandari M, Kerssens JJ, Paterson-Brown S, Parks RW (2007) Splenic trauma in Scotland: demographics and outcomes. World J Surg 31: 2111–16 (doi: https://doi.org/10.1007/s00268-007-9218-9) Crossref, MedlineGoogle Scholar
  • Brigden ML, Pattullo AL, Brown G (2004) Pneumococcal vaccine administration associated with splenectomy: the need for improved education, documentation, and the use of a practical checklist. Am J Hematol 5: 25–9 Google Scholar
  • Burch JM, Moore EE (2006) Injuries to the liver, biliary tract, spleen, and diaphragm. In: Souba WWFink MPJurkovich GJet al., eds. ACS Surgery: principles and practice. WebMD Professional Publishing, New York, NY Google Scholar
  • Clancy AA, Tiruta C, Ashman D, Ball CG, Kirkpatrick AW (2012) The song remains the same although the instruments are changing: complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a level I trauma centre from 1996 to 2007. J Trauma Manag Outcomes 6: 4 (doi: https://doi.org/10.1186/1752-2897-6-4) Crossref, MedlineGoogle Scholar
  • Cocanour CS, Moore FA, Ware DN, Marvin RG, Clark JM, Duke JH (1998) Delayed complications of nonoperative management of blunt adult splenic trauma. Arch Surg 133: 619–24 discussion 624–5 (doi: https://doi.org/10.1001/archsurg.133.6.619) Crossref, MedlineGoogle Scholar
  • Cooper MJ, Williamson RCN (1984) Splenectomy: indications, hazards and alternatives. Br J Surg 71: 173–80 Crossref, MedlineGoogle Scholar
  • Dasgupta N, Matsumoto, Arslan B, Turba UC, Sabri S, Angle JF (2010) Embolization therapy for traumatic splenic lacerations. Cardiovasc Intervent Radiol 35: 795–806 (doi: https://doi.org/10.1007/s00270-011-0186-y) CrossrefGoogle Scholar
  • Davies JM, Lewis MPN, Wimperis J, Rafi I, Ladhani S, Bolton-Maggs PHB (2011) Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology by a Working Party of the Haemato-Oncology Task Force. Br J Haematol 155: 308–17 (doi: https://doi.org/10.1111/j.1365-2141.2011.08843.x) Crossref, MedlineGoogle Scholar
  • Di Sabatino A, Carsetti R, Corazza GR (2011) Post-splenectomy and hyposplenic states. Lancet 378: 86–97 (doi: https://doi.org/10.1016/S0140-6736(10)61493-6) Crossref, MedlineGoogle Scholar
  • Dixon JA, Miller F, McCloskey D et al. (1980) Anatomy and techniques in segmental splenectomy. Surg Gynecol Obstet 150: 516–20 MedlineGoogle Scholar
  • Ellison EC, Fabri PJ (1983) Complications of splenectomy. Etiology, prevention and management. Surg Clin North Am 63: 1313–30 Crossref, MedlineGoogle Scholar
  • Garber BG, Mmath BP, Fairfull-Smith RJ, Yelle J-D (2000) Management of adult splenic injuries in Ontario: a population based study. Can J Surg 43: 283–8 MedlineGoogle Scholar
  • Haan JM, Biffl W, Knudson MM et al. (2004) Splenic embolization revisited: a multicentre review. J Trauma 56: 542–7 Crossref, MedlineGoogle Scholar
  • Hansen K, Singer DB (2001) Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. Pediatr Dev Pathol 4: 105–21 Crossref, MedlineGoogle Scholar
  • Hildebrand DR, Ben-sassi A, Ross NP, Frizelle FA, Watson AJM (2014) Modern management of splenic trauma. BMJ 348: 27–31 (doi: https://doi.org/10.1136/bmj.g1864) CrossrefGoogle Scholar
  • Kram HB, del Junco T, Clark SR, Ocampo HP, Shoemaker WC (1990) Techniques of splenic preservation using fibrin glue. J Trauma 30: 97–101 Crossref, MedlineGoogle Scholar
  • Krauth M-T, Lechner K, Neugebauer EAM, Pabinger I (2008) The postoperative splenic/portal vein thrombosis after splenectomy and its prevention – an unresolved issue. Haematologica 93: 1227–32 (doi: https://doi.org/10.3324/haematol.12682) Crossref, MedlineGoogle Scholar
  • Langley JM, Dodds L, Fell D, Langley GR (2010) Pneumococcal and influenza immunization in asplenic persons: a retrospective population based cohort study 1990-2002. BMC Infect Dis 10: 219 (doi: https://doi.org/10.1186/1471-2334-10-219) Crossref, MedlineGoogle Scholar
  • Lopera JE (2010) Embolization in trauma: principles and techniques. Semin Intervent Radiol 27: 14–28 (doi: https://doi.org/10.1055/s-0030-1247885) Crossref, MedlineGoogle Scholar
  • McInnes MDF, Kielar AZ, Macdonald DB (2011) Percutaneous image-guided biopsy of the spleen: systematic review and meta-analysis of the complication rate and diagnostic accuracy. Radiology 260: 699–708 (doi: https://doi.org/10.1148/radiol.11110333) Crossref, MedlineGoogle Scholar
  • Mebius RE, Kraal G (2005) Structure and function of the spleen. Nature Rev 5: 606–16 Google Scholar
  • Moore EE, Gogbill TH, Jurkovich GJ et al. (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 32: 323 CrossrefGoogle Scholar
  • Murken DR, Weis JJ, Hill GC et al. (2012) Radiographic assessment of splenic injury without contrast: is contrast truly needed? Surgery 152: 676–84 (doi: https://doi.org/10.1016/j.surg.2012.07.016) Crossref, MedlineGoogle Scholar
  • O'Malley DP, Kim YS, Perkins SL, Baldridge L, Juliar BE, Orazi A (2005) Morphologic and immunohistochemical evaluation of splenic hematopoietic proliferation in neoplastic and benign disorders. Mod Pathol 18: 1550–61 MedlineGoogle Scholar
  • Renzulli PR, Schnüriger B, Schoepfer AM, Inderbitzin D, Exadaktylos AK, Hoppe H, Candinas D (2010) Management of blunt injuries to the spleen. Br J Surg 97: 1696–703 Crossref, MedlineGoogle Scholar
  • Rose AT, Newman MI, Debelak J, Pinson CW, Morris JA Jr, Harley DD, Chapman WC (2000) The incidence of splenectomy is decreasing: lessons learned from trauma experience. Am Surg 66: 481–6 MedlineGoogle Scholar
  • Schneir A, Holmes JF (2001) Clinical findings in patients with splenic injuries: are injuries to the left lower chest important? Cal J Emerg Med 2: 33–6 MedlineGoogle Scholar
  • Sclafani SJA, Shaftan GW, Scalea TM et al. (1995) Non-operative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma 39: 818 Crossref, MedlineGoogle Scholar
  • Singla S, Keller D, Thirunavukarasu P, Tamandl D, Gupta SG, Gaughan J, Dempsey D (2012) Splenic injury during colonoscopy – a complication that warrants urgent attention. J Gastrointest Surg 16: 1225–34 (doi: https://doi.org/10.1007/s11605-012-1871-0) Crossref, MedlineGoogle Scholar
  • Wallis A, Kelly MD, Jones L (2010) Angiography and embolization for solid abdominal organ injury in adults – a current perspective. World J Emerg Surg 5: 18 (doi: https://doi.org/10.1186/1749-7922-5-18) Crossref, MedlineGoogle Scholar
  • Williamson JML, Rees JRE, Streets CG, Strickland AD, Finch-Jones MD (2013) Management of liver trauma. Br J Hosp Med 74: 696–702 (doi: https://doi.org/10.12968/hmed.2013.74.8.432) LinkGoogle Scholar
  • Zoli G, Corazza GR, D'Amato G, Bartoli R, Baldoni F, Gasbarrini G (1994) Splenic autotransplantation after splenectomy: tuftsin activity correlates with residual splenic function. Br J Surg 81: 716–18 Crossref, MedlineGoogle Scholar