Digestive Disease Interventions
DOI: 10.1055/s-0044-1791776
Review Article

Splenic Trauma: Concepts and Technique for Interventional Management

Rahul Dev
1   Department of Diagnostic and Intervention Radiology, AIIMS Rishikesh, India
,
Madhur Uniyal
2   Department of Trauma Surgery and Critical Care, AIIMS Rishikesh, India
,
Tripti Prajapati
1   Department of Diagnostic and Intervention Radiology, AIIMS Rishikesh, India
,
Pankaj Sharma
1   Department of Diagnostic and Intervention Radiology, AIIMS Rishikesh, India
,
1   Department of Diagnostic and Intervention Radiology, AIIMS Rishikesh, India
› Institutsangaben
Funding None.

Abstract

The spleen is the most commonly involved organ in abdominal trauma, especially in blunt mode of injury. High vascularity and a thin capsule predispose to rapid and fatal bleeding, which could be acute as well as delayed at onset. FAST is usually the first line of investigation required to see for fluid and screen patients suffering abdominal trauma. Triple-phase contrast-enhanced computed tomography of the abdomen further aids in diagnosing and grading splenic trauma as per the American Association for the Surgery of Trauma (AAST) guidelines. Hemodynamic stability and AAST grade are the main guiding parameters for management. Treatment options include surgical and nonsurgical (endovascular intervention) management. The recent concept of endovascular resuscitation and trauma management, which dwells on creating a hybrid suite, is coming up fast and will play a pivotal role in offering splenic preserving management in trauma cases. In this review article, authors have bought insights about managing splenic trauma as a multidisciplinary concept to achieve splenic preservation and maintain this vital organ's immunological functions.

Presentation at a Meeting

None.


Authors' Contribution

R.D., M.U., T.P., P.S.: concepts, design, definition of intellectual content, literature search, data acquisition, manuscript preparation, manuscript editing, manuscript review; U.C.: concepts, design, definition of intellectual content, literature search, data acquisition, manuscript preparation, manuscript editing, manuscript review, guarantor.




Publikationsverlauf

Eingereicht: 17. Mai 2024

Angenommen: 08. September 2024

Artikel online veröffentlicht:
11. Oktober 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Ardley R, Carone L, Smith S, Spreadborough S, Davies P, Brooks A. Blunt splenic injury in children: haemodynamic status key to guiding management, a 5-year review of practice in a UK major trauma centre. Eur J Trauma Emerg Surg 2019; 45 (05) 791-799
  • 2 Mebert RV, Schnüriger B, Candinas D, Haltmeier T. Follow-up imaging in patients with blunt splenic or hepatic injury managed nonoperatively. Am Surg 2018; 84 (02) 208-214
  • 3 Chaudhari PP, Rodean J, Spurrier RG. et al. Epidemiology and management of abdominal injuries in children. Acad Emerg Med 2022; 29 (08) 944-953
  • 4 Dupuy DE, Raptopoulos V, Fink MP. Current concepts in splenic trauma. J Intensive Care Med 1995; 10 (02) 76-90
  • 5 Hamilton JD, Kumaravel M, Censullo ML, Cohen AM, Kievlan DS, West OC. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 2008; 28 (06) 1603-1616
  • 6 Sclafani SJ. The role of angiographic hemostasis in salvage of the injured spleen. Radiology 1981; 141 (03) 645-650
  • 7 Zarzaur BL, Kozar RA, Fabian TC, Coimbra R. A survey of American Association for the Surgery of Trauma member practices in the management of blunt splenic injury. J Trauma 2011; 70 (05) 1026-1031
  • 8 Boscak A, Shanmuganathan K. Splenic trauma: what is new?. Radiol Clin North Am 2012; 50 (01) 105-122
  • 9 Weishaupt D, Grozaj AM, Willmann JK, Roos JE, Hilfiker PR, Marincek B. Traumatic injuries: imaging of abdominal and pelvic injuries. Eur Radiol 2002; 12 (06) 1295-1311
  • 10 Kozar RA, Crandall M, Shanmuganathan K. et al; AAST Patient Assessment Committee. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg 2018; 85 (06) 1119-1122
  • 11 Marmery H, Shanmuganathan K, Alexander MT, Mirvis SE. Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol 2007; 189 (06) 1421-1427
  • 12 Thompson BE, Munera F, Cohn SM. et al. Novel computed tomography scan scoring system predicts the need for intervention after splenic injury. J Trauma 2006; 60 (05) 1083-1086
  • 13 Baker SP, O'Neill B, Haddon Jr W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14 (03) 187-196
  • 14 Adibi A, Ferasat F, Baradaran Mahdavi MM, Kazemi K, Sadeghian S. Assessment of blunt splenic trauma: Which imaging scoring system is superior?. J Res Med Sci 2018; 23: 29
  • 15 Saksobhavivat N, Shanmuganathan K, Chen HH. et al. Blunt splenic injury: use of a multidetector CT-based splenic injury grading system and clinical parameters for triage of patients at admission. Radiology 2015; 274 (03) 702-711
  • 16 Gaetke-Udager K, Wasnik AP, Kaza RK. et al. Multimodality imaging of splenic lesions and the role of non-vascular, image-guided intervention. Abdom Imaging 2014; 39 (03) 570-587
  • 17 Valentino M, Ansaloni L, Catena F, Pavlica P, Pinna AD, Barozzi L. Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Radiol Med 2009; 114 (07) 1080-1093
  • 18 Tonolini M, Bianco R. Nontraumatic splenic emergencies: cross-sectional imaging findings and triage. Emerg Radiol 2013; 20 (04) 323-332
  • 19 Shanmuganathan K. Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR 2004; 25 (02) 180-204
  • 20 Leung V, Sastry A, Woo TD, Jones HR. Implementation of a split-bolus single-pass CT protocol at a UK major trauma centre to reduce excess radiation dose in trauma pan-CT. Clin Radiol 2015; 70 (10) 1110-1115
  • 21 Baghdanian AH, Armetta AS, Baghdanian AA, LeBedis CA, Anderson SW, Soto JA. CT of major vascular injury in blunt abdominopelvic trauma. Radiographics 2016; 36 (03) 872-890
  • 22 Shi H, Teoh WC, Chin FWK, Tirukonda PS, Cheong SCW, Yiin RSZ. CT of blunt splenic injuries: what the trauma team wants to know from the radiologist. Clin Radiol 2019; 74 (12) 903-911
  • 23 Clark TJ, Cardoza S, Kanth N. Splenic trauma: pictorial review of contrast-enhanced CT findings. Emerg Radiol 2011; 18 (03) 227-234
  • 24 Graves JA, Hanna TN, Herr KD. Pearls and pitfalls of hepatobiliary and splenic trauma: what every trauma radiologist needs to know. Emerg Radiol 2017; 24 (05) 557-568
  • 25 Federle MP, Griffiths B, Minagi H, Jeffrey Jr RB. Splenic trauma: evaluation with CT. Radiology 1987; 162 (1, Pt 1): 69-71
  • 26 Goodman LR, Aprahamian C. Changes in splenic size after abdominal trauma. Radiology 1990; 176 (03) 629-632
  • 27 Shanmuganathan K, Mirvis SE, Sover ER. Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol 1993; 161 (01) 65-69
  • 28 Furlan A, Tublin ME, Rees MA, Nicholas DH, Sperry JL, Alarcon LH. Delayed splenic vascular injury after nonoperative management of blunt splenic trauma. J Surg Res 2017; 211 (211) 87-94
  • 29 Fu CY, Wu SC, Chen RJ. et al. Evaluation of need for operative intervention in blunt splenic injury: intraperitoneal contrast extravasation has an increased probability of requiring operative intervention. World J Surg 2010; 34 (11) 2745-2751
  • 30 Raikhlin A, Baerlocher MO, Asch MR, Myers A. Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature. Can J Surg 2008; 51 (06) 464-472
  • 31 Artigas JM, Martí M, Soto JA, Esteban H, Pinilla I, Guillén E. Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings. Radiographics 2013; 33 (05) 1453-1470
  • 32 Betancourth Alvarenga JE, Santiago Martínez S, Jiménez Gómez SJ. et al. Management of splenic and/or hepatic pseudoaneurysm following abdominal trauma in pediatric patients. Cir Pediáatr 2022; 35 (02) 80-84
  • 33 Schurr MJ, Fabian TC, Gavant M. et al. Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma 1995; 39 (03) 507-512 , discussion 512–513
  • 34 Gavant ML, Schurr M, Flick PA, Croce MA, Fabian TC, Gold RE. Predicting clinical outcome of nonsurgical management of blunt splenic injury: using CT to reveal abnormalities of splenic vasculature. AJR Am J Roentgenol 1997; 168 (01) 207-212
  • 35 Patlas MN. CT imaging and management of blunt splenic trauma: lessons for today and tomorrow. Radiology 2021; 299 (01) 131-132
  • 36 Smith SR, Morris L, Spreadborough S. et al. Management of blunt splenic injury in a UK major trauma centre and predicting the failure of non-operative management: a retrospective, cross-sectional study. Eur J Trauma Emerg Surg 2018; 44 (03) 397-406
  • 37 Senekjian L, Robinson BRH, Meagher AD. et al. Nonoperative management in blunt splenic trauma: Can shock index predict failure?. J Surg Res 2022; 276: 340-346
  • 38 Palas J, Matos AP, Ramalho M. The spleen revisited: an overview on magnetic resonance imaging. Radiol Res Pract 2013; 2013: 219-297
  • 39 Stassen NA, Bhullar I, Cheng JD. et al; Eastern Association for the Surgery of Trauma. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73 (5, Suppl 4): S288-S293
  • 40 Hildebrand DR, Ben-Sassi A, Ross NP, Macvicar R, Frizelle FA, Watson AJ. Modern management of splenic trauma. BMJ 2014; 348: g1864
  • 41 Shatz DV, de Moya M, Brasel KJ. et al. Blunt splenic injury, emergency department to discharge: a Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg 2023; 94 (03) 448-454
  • 42 Lo A, Matheson AM, Adams D. Impact of concomitant trauma in the management of blunt splenic injuries. N Z Med J 2004; 117 (1201) U1052
  • 43 Wahl WL, Ahrns KS, Chen S, Hemmila MR, Rowe SA, Arbabi S. Blunt splenic injury: operation versus angiographic embolization. Surgery 2004; 136 (04) 891-899
  • 44 Bratzler DW, Dellinger EP, Olsen KM. et al; American Society of Health-System Pharmacists, Infectious Disease Society of America, Surgical Infection Society, Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70 (03) 195-283
  • 45 Tsuei BJ, Kearney PA. Hypothermia in the trauma patient. Injury 2004; 35 (01) 7-15
  • 46 Root HD. Splenic injury: angiogram vs. operation. J Trauma 2007; 62 (06) S27
  • 47 Dent D. Splenic injury: angio vs. operation. J Trauma 2007; 62 (06) S26
  • 48 Franklin GA, Casós SR. Current advances in the surgical approach to abdominal trauma. Injury 2006; 37 (12) 1143-1156
  • 49 Casali M, Di Saverio S, Tugnoli G. et al. Traumi penetranti dell'addome. Esperienza di 20 anni in Trauma Center dell'Europa Occidentale. [Penetrating abdominal trauma: 20 years experience in a Western European Trauma Center] Ann Ital Chir 2008; 79 (06) 399-407
  • 50 Harbrecht BG, Zenati MS, Ochoa JB, Puyana JC, Alarcon LH, Peitzman AB. Evaluation of a 15-year experience with splenic injuries in a state trauma system. Surgery 2007; 141 (02) 229-238
  • 51 Styrt B. Infection associated with asplenia: risks, mechanisms, and prevention. Am J Med 1990; 88 (5N): 33N-42N
  • 52 Tsaroucha AK, Pitiakoudis MS, Chanos G. et al. U-stitching splenorraphy technique: experimental and clinical study. ANZ J Surg 2005; 75 (04) 208-212
  • 53 Surendran A, Smith M, Houli N, Usatoff V, Spelman D, Choi J. Splenic autotransplantation: a systematic review. ANZ J Surg 2020; 90 (04) 460-466
  • 54 Cardoso DL, Cardoso Filho FA, Cardoso AL, Gonzaga ML, Grande AJ. Should splenic autotransplantation be considered after total splenectomy due to trauma?. Rev Col Bras Cir 2018; 45 (03) e1850 English, Portuguese
  • 55 Fremont RD, Rice TW. Splenosis: a review. South Med J 2007; 100 (06) 589-593
  • 56 Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet 2011; 378 (9785) 86-97
  • 57 Corazza GR, Tarozzi C, Vaira D, Frisoni M, Gasbarrini G. Return of splenic function after splenectomy: how much tissue is needed?. Br Med J (Clin Res Ed) 1984; 289 (6449) 861-864
  • 58 Connell NT, Brunner AM, Kerr CA, Schiffman FJ. Splenosis and sepsis: the born-again spleen provides poor protection. Virulence 2011; 2 (01) 4-11
  • 59 Segalini E, Khan M, Podda M. et al. The role of laparoscopic splenectomy in traumatic splenic injury: a narrative review. Minerva Surg 2023; 78 (01) 76-80
  • 60 Fransvea P, Costa G, Serao A. et al. Laparoscopic splenectomy after trauma: Who, when and how. A systematic review. J Minim Access Surg 2021; 17 (02) 141-146
  • 61 Pucci E, Brody F, Zemon H, Ponsky T, Venbrux A. Laparoscopic splenectomy for delayed splenic rupture after embolization. J Trauma 2007; 63 (03) 687-690
  • 62 Ren CJ, Salky B, Reiner M. Hand-assisted laparoscopic splenectomy for ruptured spleen. Surg Endosc 2001; 15 (03) 324
  • 63 Basso N, Silecchia G, Raparelli L, Pizzuto G, Picconi T. Laparoscopic splenectomy for ruptured spleen: lessons learned from a case. J Laparoendosc Adv Surg Tech A 2003; 13 (02) 109-112
  • 64 Huscher CG, Mingoli A, Sgarzini G. et al. Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients. Surg Endosc 2006; 20 (09) 1423-1426
  • 65 Carobbi A, Romagnani F, Antonelli G, Bianchini M. Laparoscopic splenectomy for severe blunt trauma: initial experience of ten consecutive cases with a fast hemostatic technique. Surg Endosc 2010; 24 (06) 1325-1330
  • 66 Kawahara NT, Alster C, Fujimura I, Poggetti RS, Birolini D. Standard examination system for laparoscopy in penetrating abdominal trauma. J Trauma 2009; 67 (03) 589-595
  • 67 Sauerland S, Agresta F, Bergamaschi R. et al. Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 2006; 20 (01) 14-29
  • 68 Ayiomamitis GD, Alkari B, Owera A, Ammori BJ. Emergency laparoscopic splenectomy for splenic trauma in a Jehovah's Witness patient. Surg Laparosc Endosc Percutan Tech 2008; 18 (06) 626-630
  • 69 Huang GS, Chance EA, Hileman BM, Emerick ES, Gianetti EA. Laparoscopic splenectomy in hemodynamically stable blunt trauma. JSLS 2017; 21 (02) e2017.00013
  • 70 Chia TL, Chesney TR, Isa D. et al. Thrombocytosis in splenic trauma: in-hospital course and association with venous thromboembolism. Injury 2017; 48 (01) 142-147
  • 71 Kwok AM, Davis JW, Dirks RC, Wolfe MM, Kaups KL. Time is now: venous thromboembolism prophylaxis in blunt splenic injury. Am J Surg 2016; 212 (06) 1231-1236
  • 72 Lin JN, Chen HJ, Lin MC. et al. Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study. Thromb Haemost 2016; 115 (01) 176-183
  • 73 Mukherjee D, Lidor AO, Chu KM, Gearhart SL, Haut ER, Chang DC. Postoperative venous thromboembolism rates vary significantly after different types of major abdominal operations. J Gastrointest Surg 2008; 12 (11) 2015-2022
  • 74 Tinkoff G, Esposito TJ, Reed J. et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg 2008; 207 (05) 646-655
  • 75 Clancy TV, Ramshaw DG, Maxwell JG. et al. Management outcomes in splenic injury: a statewide trauma center review. Ann Surg 1997; 226 (01) 17-24
  • 76 Livingston CD, Sirinek KR, Levine BA, Aust JB. Traumatic splenic injury: its management in a patient population with a high incidence of associated injury. Arch Surg 1982; 117 (05) 670-674
  • 77 Shackford SR, Molin M. Management of splenic injuries. Surg Clin North Am 1990; 70 (03) 595-620
  • 78 Boxer MA, Braun J, Ellman L. Thromboembolic risk of postsplenectomy thrombocytosis. Arch Surg 1978; 113 (07) 808-809
  • 79 Watters JM, Sambasivan CN, Zink K. et al. Splenectomy leads to a persistent hypercoagulable state after trauma. Am J Surg 2010; 199 (05) 646-651
  • 80 Stamou KM, Toutouzas KG, Kekis PB. et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins. Arch Surg 2006; 141 (07) 663-669
  • 81 Khan PN, Nair RJ, Olivares J, Tingle LE, Li Z. Postsplenectomy reactive thrombocytosis. Proc Bayl Univ Med Cent 2009; 22 (01) 9-12
  • 82 Gauer JM, Gerber-Paulet S, Seiler C, Schweizer WP. Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy. World J Surg 2008; 32 (12) 2730-2735
  • 83 Schwartz PE, Sterioff S, Mucha P, Melton III LJ, Offord KP. Postsplenectomy sepsis and mortality in adults. JAMA 1982; 248 (18) 2279-2283
  • 84 Forsythe RM, Harbrecht BG, Peitzman AB. Blunt splenic trauma. Scand J Surg 2006; 95 (03) 146-151
  • 85 Shatz DV. Vaccination practices among North American trauma surgeons in splenectomy for trauma. J Trauma 2002; 53 (05) 950-956
  • 86 Hörer TM, Pirouzram A, Khan M. et al; Damage Control Resuscitation Committee. Endovascular resuscitation and trauma management (EVTM)-practical aspects and implementation. Shock 2021; 56 (1S): 37-41
  • 87 Haan J, Scott J, Boyd-Kranis RL, Ho S, Kramer M, Scalea TM. Admission angiography for blunt splenic injury: advantages and pitfalls. J Trauma 2001; 51 (06) 1161-1165
  • 88 Koury HI, Peschiera JL, Welling RE. Non-operative management of blunt splenic trauma: a 10-year experience. Injury 1991; 22 (05) 349-352
  • 89 Bessoud B, Denys A, Calmes JM. et al. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization?. AJR Am J Roentgenol 2006; 186 (03) 779-785
  • 90 Bugaev N, Breeze JL, Daoud V, Arabian SS, Rabinovici R. Management and outcome of patients with blunt splenic injury and preexisting liver cirrhosis. J Trauma Acute Care Surg 2014; 76 (06) 1354-1361
  • 91 Velmahos GC, Zacharias N, Emhoff TA. et al. Management of the most severely injured spleen: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Arch Surg 2010; 145 (05) 456-460
  • 92 Olthof DC, Joosse P, van der Vlies CH, de Haan RJ, Goslings JC. Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: a systematic review. J Trauma Acute Care Surg 2013; 74 (02) 546-557
  • 93 Teixeira PG, Karamanos E, Okoye OT. et al. Splenectomy in patients with traumatic brain injury: protective or harmful? A National Trauma Data Bank analysis. J Trauma Acute Care Surg 2013; 75 (04) 596-601
  • 94 Arvieux C, Frandon J, Tidadini F. et al; Splenic Arterial Embolization to Avoid Splenectomy (SPLASH) Study Group. Effect of prophylactic embolization on patients with blunt trauma at high risk of splenectomy: a randomized clinical trial. JAMA Surg 2020; 155 (12) 1102-1111
  • 95 Rong JJ, Liu D, Liang M. et al. The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis. Mil Med Res 2017; 4: 17
  • 96 Abbey-Mensah G, Herskowitz MM, Walsh J, Leonardo RF. Massive hematemesis from a splenic artery pseudoaneurysm presenting two years after penetrating trauma. Case Rep Radiol 2018; 2018: 7473168
  • 97 Loffroy R, Guiu B, Cercueil JP. et al. Transcatheter arterial embolization of splenic artery aneurysms and pseudoaneurysms: short- and long-term results. Ann Vasc Surg 2008; 22 (05) 618-626
  • 98 Norotsky MC, Rogers FB, Shackford SR. Delayed presentation of splenic artery pseudoaneurysms following blunt abdominal trauma: case reports. J Trauma 1995; 38 (03) 444-447
  • 99 Schnüriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma 2011; 70 (01) 252-260
  • 100 Wu SC, Chen RJ, Yang AD, Tung CC, Lee KH. Complications associated with embolization in the treatment of blunt splenic injury. World J Surg 2008; 32 (03) 476-482
  • 101 Uecker J, Pickett C, Dunn E. The role of follow-up radiographic studies in nonoperative management of spleen trauma. Am Surg 2001; 67 (01) 22-25
  • 102 Savage SA, Zarzaur BL, Magnotti LJ. et al. The evolution of blunt splenic injury: resolution and progression. J Trauma 2008; 64 (04) 1085-1091 , discussion 1091–1092
  • 103 Weinberg JA, Magnotti LJ, Croce MA, Edwards NM, Fabian TC. The utility of serial computed tomography imaging of blunt splenic injury: still worth a second look?. J Trauma 2007; 62 (05) 1143-1147 , discussion 1147–1148
  • 104 Wallen TE, Clark K, Baucom MR. et al. Delayed splenic pseudoaneurysm identification with surveillance imaging. J Trauma Acute Care Surg 2022; 93 (01) 113-117
  • 105 Cinquantini F, Simonini E, Di Saverio S. et al. Non-surgical management of blunt splenic trauma: a comparative analysis of non-operative management and splenic artery embolization-experience from a European trauma center. Cardiovasc Intervent Radiol 2018; 41 (09) 1324-1332
  • 106 Ahuja C, Farsad K, Chadha M. An overview of splenic embolization. AJR Am J Roentgenol 2015; 205 (04) 720-725
  • 107 de Porto AP, Lammers AJ, Bennink RJ, ten Berge IJ, Speelman P, Hoekstra JB. Assessment of splenic function. Eur J Clin Microbiol Infect Dis 2010; 29 (12) 1465-1473
  • 108 Smith J, Armen S, Cook CH, Martin LC. Blunt splenic injuries: have we watched long enough?. J Trauma 2008; 64 (03) 656-663 , discussion 663–665
  • 109 Malhotra AK, Carter RF, Lebman DA. et al. Preservation of splenic immunocompetence after splenic artery angioembolization for blunt splenic injury. J Trauma 2010; 69 (05) 1126-1130 , discussion 1130–1131
  • 110 Cioci AC, Parreco JP, Lindenmaier LB. et al. Readmission for infection after blunt splenic injury: a national comparison of management techniques. J Trauma Acute Care Surg 2020; 88 (03) 390-395
  • 111 McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg 2005; 140 (06) 563-568 , discussion 568–569
  • 112 Peitzman AB, Heil B, Rivera L. et al. Blunt splenic injury in adults: multi-institutional study of the Eastern Association for the Surgery of Trauma. J Trauma 2000; 49 (02) 177-187 , discussion 187–189
  • 113 Bhangu A, Nepogodiev D, Lal N, Bowley DM. Meta-analysis of predictive factors and outcomes for failure of non-operative management of blunt splenic trauma. Injury 2012; 43 (09) 1337-1346
  • 114 Bala M, Edden Y, Mintz Y. et al. Blunt splenic trauma: predictors for successful non-operative management. Isr Med Assoc J 2007; 9 (12) 857-861
  • 115 Scarborough JE, Ingraham AM, Liepert AE, Jung HS, O'Rourke AP, Agarwal SK. Nonoperative management is as effective as immediate splenectomy for adult patients with high-grade blunt splenic injury. J Am Coll Surg 2016; 223 (02) 249-258
  • 116 Peitzman AB, Harbrecht BG, Rivera L, Heil B. Eastern Association for the Surgery of Trauma Multiinstitutional Trials Workgroup. Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg 2005; 201 (02) 179-187
  • 117 Liu PP, Liu HT, Hsieh TM, Huang CY, Ko SF. Nonsurgical management of delayed splenic rupture after blunt trauma. J Trauma Acute Care Surg 2012; 72 (04) 1019-1023
  • 118 Rosenberg GM, Knowlton L, Rajasingh C. et al. National readmission patterns of isolated splenic injuries based on initial management strategy. JAMA Surg 2017; 152 (12) 1119-1125