Materiały źródłowe

• #1 Splenic Trauma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430920/

  Most references suggest the spleen is the most commonly injured solid organ in trauma for both blunt and penetrating mechanisms. […] The wound of a penetrating trauma need not be near the spleen to cause significant injury. […] Other severe injuries can be associated with spleen trauma, so these should be looked for during patient assessment.

• #2 Ruptured spleen (ruptured spleen) – USZ

  https://www.usz.ch/en/disease/ruptured-spleen/

  The frequency of splenic rupture cannot be precisely quantified. In the case of blunt abdominal trauma, however, the spleen is the most frequently damaged organ in the abdominal cavity, accounting for up to 45 percent of cases. About five to six percent are bilateral splenic ruptures (less in children). Non-traumatic splenic ruptures, for example in the context of infections or inflammations, occur less frequently in comparison. […] In principle, a ruptured spleen can affect people of any age: Children, adolescents, adults and senior citizens. In addition, people of any gender can suffer a ruptured spleen. […] Traumatic splenic rupture is often caused by a car accident, sports accident or accident at work. In addition to the ruptured spleen, patients often have other injuries that we need to look at. […] If specialists diagnose and treat the ruptured spleen in good time, the course and prognosis are generally favorable. Mortality is low in this case. However, both depend on whether other injuries are present, which is often the case in a car accident, for example.

• #3 Ruptured Spleen: Causes, Symptoms, Treatment, Recovery

  https://www.healthline.com/health/ruptured-spleen

  A ruptured spleen is a life threatening medical emergency. It requires immediate medical attention. […] In the United States, about 40,000 people experience a spleen injury each year. […] The majority of ruptured spleens are caused by trauma. […] A ruptured spleen is a medical emergency. You should seek immediate medical attention if you have symptoms of a ruptured spleen. […] A ruptured spleen can be a life threatening condition and requires immediate attention. […] In most cases, a ruptured spleen is caused by blunt force trauma. […] If you’ve been injured and have symptoms of a ruptured spleen, seek emergency care right away.

• #4 Ruptured spleen (ruptured spleen) – USZ

  https://www.usz.ch/en/disease/ruptured-spleen/

  The frequency of splenic rupture cannot be precisely quantified. In the case of blunt abdominal trauma, however, the spleen is the most frequently damaged organ in the abdominal cavity, accounting for up to 45 percent of cases. About five to six percent are bilateral splenic ruptures (less in children). Non-traumatic splenic ruptures, for example in the context of infections or inflammations, occur less frequently in comparison. […] In principle, a ruptured spleen can affect people of any age: Children, adolescents, adults and senior citizens. In addition, people of any gender can suffer a ruptured spleen. […] Traumatic splenic rupture is often caused by a car accident, sports accident or accident at work. In addition to the ruptured spleen, patients often have other injuries that we need to look at. […] If specialists diagnose and treat the ruptured spleen in good time, the course and prognosis are generally favorable. Mortality is low in this case. However, both depend on whether other injuries are present, which is often the case in a car accident, for example.

• #5 Splenic trauma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/splenic-trauma?lang=us

  Splenic trauma can occur after blunt or penetrating trauma or secondary to medical intervention (i.e. iatrogenic). The spleen is the most frequently injured internal organ after blunt trauma. […] In blunt trauma, the spleen can account for up to 49% of abdominal organ injuries. […] In penetrating trauma, the spleen is more likely to be injured than bowel.

• #6 Splenic Rupture: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/432823-overview

  Determining the actual frequency of splenic injuries with precision in the United States or worldwide is not possible. Hospital discharge data may not document the injury if there are numerous, more serious injuries or diseases. A general consensus of trauma admissions at Level 1 trauma centers across the country suggests splenic injury occurs in as many as 25% of the average 800-1200 admissions for blunt trauma per year. This is a select population of patients with multiple injuries and does not take into account isolated splenic injuries observed and treated at nontrauma centers. […] A thorough knowledge of splenic function, anatomy, and pathophysiology is necessary to continue the progress of the last decade and to decrease the mortality rate from this common injury in the United States and worldwide.

• #7 Splenic Rupture: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/432823-overview

  Determining the actual frequency of splenic injuries with precision in the United States or worldwide is not possible. Hospital discharge data may not document the injury if there are numerous, more serious injuries or diseases. A general consensus of trauma admissions at Level 1 trauma centers across the country suggests splenic injury occurs in as many as 25% of the average 800-1200 admissions for blunt trauma per year. This is a select population of patients with multiple injuries and does not take into account isolated splenic injuries observed and treated at nontrauma centers. […] A thorough knowledge of splenic function, anatomy, and pathophysiology is necessary to continue the progress of the last decade and to decrease the mortality rate from this common injury in the United States and worldwide.

• #8 Splenic Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525951/

  The prevalence of splenic ruptures is not widely reported in the literature. The mechanism of the majority of traumatic ruptures continues to be motor vehicle injury, followed by direct abdominal blows. Sports such as football, hockey, and bicycling increase the risk of abdominal, and, therefore, splenic injury and rupture. One study suggests that traumatic splenic ruptures are more likely to occur in males (2:1 male to female) in ages ranging from 18 to 34 years. […] The following are six major causes of non-traumatic rupture: Neoplasm, 30%; Infectious, 30%; Inflammatory disease, 15%; Medication and medical treatment, 10%; Mechanical causes, 7%; Idiopathic, 7%.

• #9 Splenic Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525951/

  The prevalence of splenic ruptures is not widely reported in the literature. The mechanism of the majority of traumatic ruptures continues to be motor vehicle injury, followed by direct abdominal blows. Sports such as football, hockey, and bicycling increase the risk of abdominal, and, therefore, splenic injury and rupture. One study suggests that traumatic splenic ruptures are more likely to occur in males (2:1 male to female) in ages ranging from 18 to 34 years. […] The following are six major causes of non-traumatic rupture: Neoplasm, 30%; Infectious, 30%; Inflammatory disease, 15%; Medication and medical treatment, 10%; Mechanical causes, 7%; Idiopathic, 7%.

• #10 Rupture of the Spleen | Concise Medical Knowledge

  https://www.lecturio.com/concepts/rupture-of-the-spleen/

  Splenic rupture is often associated with trauma (e.g., motor vehicle accident) that causes a laceration of the organ. […] The spleen is the most commonly injured and ruptured organ in the abdomen: 50%-75% of cases caused by blunt trauma (most common cause). Rate of injury after blunt abdominal trauma may be as high as 7.5%. […] More common in males. […] Peak incidence in young adults (ages 18-34).

• #11 Spontaneous Rupture of the Spleen: A Case Report and Review of the Literature

  https://www.ej-med.org/index.php/ejmed/article/view/2147

  Non-traumatic ruptures of the spleen are rare, difficult to diagnose and potentially fatal. […] Mortality in this condition is essentially linked to delays in diagnosis and treatment, as well as to risks associated with the terrain and severity of the underlying pathology. […] Spontaneous splenic rupture is a rare disease that was first documented in the 19th century. […] It has a male predominance, and the mean age in the largest series was 45 years, with a mortality rate between 12% and 20%. […] The diagnosis of splenic rupture is challenging. […] Radiology is the key to suggesting the diagnosis; ultrasound is the first imaging to demand its low specificity. […] Management of SSR primarily depends on the patients hemodynamic stability. […] In the case of splenectomy, post-operative care is important. […] Spontaneous rupture of the spleen is a rare entity whose diagnosis is difficult in the absence of a traumatic context and can be life-threatening.

• #12 SPLEEN INJURIES | Sports Medicine Today

  https://www.sportsmedtoday.com/spleen-injuries-va-237.htm

  Spleen injuries in athletes are rare, but potentially life-threatening if missed. […] Splenomegaly is found in 50-60% of patients with IM, and splenic rupture occurs in approximately 1-2 in 1000 of these patients. […] Seventy percent of splenic ruptures in patients with IM are males under 30 years old. […] Some risks that increase the chance of splenic injury include a current or recent diagnosis of IM, participation in contact sports, mountain climbing, skiing, bicycles without handlebar padding, weightlifting (Valsalva), and an improperly tacked horse (saddle, stirrups, etc.). […] After an IM infection the literature suggests that athletes in non-contact sports can return to play in 21 days, while athletes in contact sports can return to play in 30 days.

• #13 Epidemiology and management of splenic injury: An analysis of a Chinese military registry

  https://www.spandidos-publications.com/10.3892/etm.2017.4208

  In China, there have been few meta-analyses of the epidemiology and management of splenic injury. […] It was observed that between July 2000 and March 2009 a total of 7,807 patients (84.32% male and 15.68% female) with splenic injury were admitted to hospital. […] The present study analyzed the data of inpatients admitted to Chinese military hospitals with splenic injury, with the aim of identifying the pattern, incidence and management strategies of splenic trauma. Understanding the epidemiology and management of splenic injury may aid in the prevention of splenic injury and reduce its incidence, fatality and disability rates. […] The present study evaluated a large sample of patients admitted to Chinese military hospitals with splenic injuries over a ~10 year period. Analysis of the patient data suggested that there were differences in admission dates, patient ages and factors influencing mortality rate, relative to studies conducted in other countries and regions. The present findings also indicate the epidemiology and management strategies of splenic injury in China, which may aid in improving the prognosis and treatment methods for splenic trauma patients in the future.

• #14 Ruptured Spleen: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17953-ruptured-spleen

  A ruptured spleen can cause life-threatening internal bleeding. […] A ruptured spleen is a medical emergency that requires swift diagnosis and intervention, and sometimes surgery. […] Traumatic injuries are the most common causes of splenic rupture, especially car accidents, which cause 50% to 75%. […] Non-traumatic or spontaneous splenic rupture is rare but possible. […] If your FAST ultrasound is positive and your vital signs remain unstable, your healthcare team will know that you have a ruptured spleen and need immediate treatment. […] Treatment depends on the extent of your injury. […] The outcome depends on how severe your injury is and how quickly it gets diagnosed and treated. […] A ruptured spleen is an emergency, whether it’s minor or severe. Any internal bleeding can be life-threatening if it isnt managed.

• #15 Rupture of the Spleen | Concise Medical Knowledge

  https://www.lecturio.com/concepts/rupture-of-the-spleen/

  Splenic rupture is often associated with trauma (e.g., motor vehicle accident) that causes a laceration of the organ. […] The spleen is the most commonly injured and ruptured organ in the abdomen: 50%-75% of cases caused by blunt trauma (most common cause). Rate of injury after blunt abdominal trauma may be as high as 7.5%. […] More common in males. […] Peak incidence in young adults (ages 18-34).

• #16 Splenic Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525951/

  The prevalence of splenic ruptures is not widely reported in the literature. The mechanism of the majority of traumatic ruptures continues to be motor vehicle injury, followed by direct abdominal blows. Sports such as football, hockey, and bicycling increase the risk of abdominal, and, therefore, splenic injury and rupture. One study suggests that traumatic splenic ruptures are more likely to occur in males (2:1 male to female) in ages ranging from 18 to 34 years. […] The following are six major causes of non-traumatic rupture: Neoplasm, 30%; Infectious, 30%; Inflammatory disease, 15%; Medication and medical treatment, 10%; Mechanical causes, 7%; Idiopathic, 7%.

• #17 Ruptured spleen (ruptured spleen) – USZ

  https://www.usz.ch/en/disease/ruptured-spleen/

  The frequency of splenic rupture cannot be precisely quantified. In the case of blunt abdominal trauma, however, the spleen is the most frequently damaged organ in the abdominal cavity, accounting for up to 45 percent of cases. About five to six percent are bilateral splenic ruptures (less in children). Non-traumatic splenic ruptures, for example in the context of infections or inflammations, occur less frequently in comparison. […] In principle, a ruptured spleen can affect people of any age: Children, adolescents, adults and senior citizens. In addition, people of any gender can suffer a ruptured spleen. […] Traumatic splenic rupture is often caused by a car accident, sports accident or accident at work. In addition to the ruptured spleen, patients often have other injuries that we need to look at. […] If specialists diagnose and treat the ruptured spleen in good time, the course and prognosis are generally favorable. Mortality is low in this case. However, both depend on whether other injuries are present, which is often the case in a car accident, for example.

• #18 Splenic Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525951/

  The prevalence of splenic ruptures is not widely reported in the literature. The mechanism of the majority of traumatic ruptures continues to be motor vehicle injury, followed by direct abdominal blows. Sports such as football, hockey, and bicycling increase the risk of abdominal, and, therefore, splenic injury and rupture. One study suggests that traumatic splenic ruptures are more likely to occur in males (2:1 male to female) in ages ranging from 18 to 34 years. […] The following are six major causes of non-traumatic rupture: Neoplasm, 30%; Infectious, 30%; Inflammatory disease, 15%; Medication and medical treatment, 10%; Mechanical causes, 7%; Idiopathic, 7%.

• #19 Splenic Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525951/

  The prevalence of splenic ruptures is not widely reported in the literature. The mechanism of the majority of traumatic ruptures continues to be motor vehicle injury, followed by direct abdominal blows. Sports such as football, hockey, and bicycling increase the risk of abdominal, and, therefore, splenic injury and rupture. One study suggests that traumatic splenic ruptures are more likely to occur in males (2:1 male to female) in ages ranging from 18 to 34 years. […] The following are six major causes of non-traumatic rupture: Neoplasm, 30%; Infectious, 30%; Inflammatory disease, 15%; Medication and medical treatment, 10%; Mechanical causes, 7%; Idiopathic, 7%.

• #20

  https://step2.medbullets.com/gastrointestinal/121859/splenic-laceration–rupture

  Epidemiology […] Risk factors […] diseases causing splenomegaly […] infectious mononucleosis […] dengue fever […] leukemia/lymphoma […] malaria […] malignancies […] penetrating trauma […] blunt trauma […] left-sided rib fracture

• #21 Ruptured Spleen: Symptoms, Causes, Treatment

  https://www.health.com/ruptured-spleen-8638583

  A ruptured spleen, or splenic rupture, is when the spleen tears open. […] While splenic ruptures are not common, the spleen is the most frequently injured organ in the abdomen, accounting for 42% of all traumatic abdominal injuries. […] A ruptured spleen occurs when the spleen’s capsulethe thick layer of connective tissue surrounding the spleentears and bleeds. […] The most common cause of a ruptured spleen is blunt trauma to the abdomen, meaning a forceful impact on the belly, often from a car accident, sports injury, or fall. […] Although rare, some illnesses that cause inflammation and enlargement of the spleen (splenomegaly) can weaken the spleen’s capsule and lead to non-traumatic (spontaneous) splenic rupture. […] Certain factors can increase your risk of a ruptured spleen, including contact sports, underlying conditions, and previous abdominal surgery or procedures.

• #22

  https://step2.medbullets.com/gastrointestinal/121859/splenic-laceration–rupture

  Epidemiology […] Risk factors […] diseases causing splenomegaly […] infectious mononucleosis […] dengue fever […] leukemia/lymphoma […] malaria […] malignancies […] penetrating trauma […] blunt trauma […] left-sided rib fracture

• #23 Ruptured Spleen: Symptoms, Causes, Treatment

  https://www.health.com/ruptured-spleen-8638583

  A ruptured spleen, or splenic rupture, is when the spleen tears open. […] While splenic ruptures are not common, the spleen is the most frequently injured organ in the abdomen, accounting for 42% of all traumatic abdominal injuries. […] A ruptured spleen occurs when the spleen’s capsulethe thick layer of connective tissue surrounding the spleentears and bleeds. […] The most common cause of a ruptured spleen is blunt trauma to the abdomen, meaning a forceful impact on the belly, often from a car accident, sports injury, or fall. […] Although rare, some illnesses that cause inflammation and enlargement of the spleen (splenomegaly) can weaken the spleen’s capsule and lead to non-traumatic (spontaneous) splenic rupture. […] Certain factors can increase your risk of a ruptured spleen, including contact sports, underlying conditions, and previous abdominal surgery or procedures.

• #24 Delayed Splenic Rupture Following Minor Trauma in a Patient with Underlying Liver Cirrhosis

  https://jtraumainj.org/journal/view.php?number=118

  The spleen is the most frequently injured organ following blunt abdominal trauma. However, delayed splenic rupture is rare. […] The diagnosis of delayed splenic rupture could be challenging if the trauma is minor and remote. […] In the present case, the thrombocytopenia and splenomegaly due to liver cirrhosis are suspected of being risk factors for the development of delayed splenic rupture. The physician should keep in mind the possibility of delayed splenic rupture following blunt abdominal or chest trauma.

• #25 Splenic Rupture Following Colonoscopy | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n1/foster-splenic-rupture/

  Splenic rupture is a serious complication of any colonoscopy. […] Literature reports splenic trauma with colonoscopy to have an incidence of approximately 0.0005%-0.017% and a mortality rate of 5%. […] Splenic injuries can be a fatal complication of colonoscopies that, although rare, are likely more common than the literature shows, given the presence of under-reporting. […] The most common presenting symptoms consist of abdominal pain (46.1%), left shoulder pain (40.91%), dizziness/lightheadedness (7.79%), and syncope/collapse (5.19%). […] The mechanism of splenic rupture following endoscopy is not fully understood, but several theories exist. […] Regardless, the colonoscopist should take special precautions to avoid excessive traction while navigating the splenic flexure. In addition, the emergency department physician should have a high index of suspicion of possible splenic rupture if a patient presents with abdominal pain following a recent colonoscopy.

• #26 Splenic laceration after routine colonoscopy, a case report of a rare iatrogenic complication – Li – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/3753/html

  Given the estimated colonoscopy performed, this extrapolates to an annual incidence of at least 224 cases of splenic injury in the United States alone if we assume an incidence rate of 1 in 100,000. Yet, only 172 cases have been reported in the medical literature to date. This suggests the majority of splenic injuries resulting from colonoscopy may be undetected or not reported. […] Overall, splenic injury from colonoscopy is more prevalent in women with a near 3 to 1 ratio for unknown reasons. […] Advanced age is proposed to be a possible risk factor for splenic injury, with average age of occurrence of 63.0 years. However, this may be less of a risk factor, but rather an indicator of the patient population undergoing colonoscopies. […] The mechanisms of injury are proposed to be traction on the splenocolic ligament and/or due to adhesions between the splenic flexure and the spleen in patients with prior abdominal surgery.

• #27 Rupture of the Spleen | Concise Medical Knowledge

  https://www.lecturio.com/concepts/rupture-of-the-spleen/

  Splenic rupture is often associated with trauma (e.g., motor vehicle accident) that causes a laceration of the organ. […] The spleen is the most commonly injured and ruptured organ in the abdomen: 50%-75% of cases caused by blunt trauma (most common cause). Rate of injury after blunt abdominal trauma may be as high as 7.5%. […] More common in males. […] Peak incidence in young adults (ages 18-34).

• #28 Epidemiology and management of splenic injury: An analysis of a Chinese military registry

  https://www.spandidos-publications.com/10.3892/etm.2017.4208

  In China, there have been few meta-analyses of the epidemiology and management of splenic injury. […] It was observed that between July 2000 and March 2009 a total of 7,807 patients (84.32% male and 15.68% female) with splenic injury were admitted to hospital. […] The present study analyzed the data of inpatients admitted to Chinese military hospitals with splenic injury, with the aim of identifying the pattern, incidence and management strategies of splenic trauma. Understanding the epidemiology and management of splenic injury may aid in the prevention of splenic injury and reduce its incidence, fatality and disability rates. […] The present study evaluated a large sample of patients admitted to Chinese military hospitals with splenic injuries over a ~10 year period. Analysis of the patient data suggested that there were differences in admission dates, patient ages and factors influencing mortality rate, relative to studies conducted in other countries and regions. The present findings also indicate the epidemiology and management strategies of splenic injury in China, which may aid in improving the prognosis and treatment methods for splenic trauma patients in the future.

• #29 Epidemiology and management of splenic injury: An analysis of a Chinese military registry

  https://www.spandidos-publications.com/10.3892/etm.2017.4208

  In China, there have been few meta-analyses of the epidemiology and management of splenic injury. […] It was observed that between July 2000 and March 2009 a total of 7,807 patients (84.32% male and 15.68% female) with splenic injury were admitted to hospital. […] The present study analyzed the data of inpatients admitted to Chinese military hospitals with splenic injury, with the aim of identifying the pattern, incidence and management strategies of splenic trauma. Understanding the epidemiology and management of splenic injury may aid in the prevention of splenic injury and reduce its incidence, fatality and disability rates. […] The present study evaluated a large sample of patients admitted to Chinese military hospitals with splenic injuries over a ~10 year period. Analysis of the patient data suggested that there were differences in admission dates, patient ages and factors influencing mortality rate, relative to studies conducted in other countries and regions. The present findings also indicate the epidemiology and management strategies of splenic injury in China, which may aid in improving the prognosis and treatment methods for splenic trauma patients in the future.

• #30 Splenic Ruptures: What Athletes Need to Know | Texas Children’s

  https://www.texaschildrens.org/content/wellness/splenic-ruptures-what-athletes-need-know

  A ruptured spleen is most often from a direct blow to the abdomen which means there is always a risk for this to occur with contact sports such as football and soccer. […] There is, however, a viral infection called mononucleosis that puts athletes at a higher risk for splenic rupture. […] Despite this known risk splenic rupture is still not common and only 0.1% of people diagnosed with mononucleosis have this complication.

• #31 Splenic Ruptures: What Athletes Need to Know | Texas Children’s

  https://www.texaschildrens.org/content/wellness/splenic-ruptures-what-athletes-need-know

  A ruptured spleen is most often from a direct blow to the abdomen which means there is always a risk for this to occur with contact sports such as football and soccer. […] There is, however, a viral infection called mononucleosis that puts athletes at a higher risk for splenic rupture. […] Despite this known risk splenic rupture is still not common and only 0.1% of people diagnosed with mononucleosis have this complication.

• #32 SPLEEN INJURIES | Sports Medicine Today

  https://www.sportsmedtoday.com/spleen-injuries-va-237.htm

  Spleen injuries in athletes are rare, but potentially life-threatening if missed. […] Splenomegaly is found in 50-60% of patients with IM, and splenic rupture occurs in approximately 1-2 in 1000 of these patients. […] Seventy percent of splenic ruptures in patients with IM are males under 30 years old. […] Some risks that increase the chance of splenic injury include a current or recent diagnosis of IM, participation in contact sports, mountain climbing, skiing, bicycles without handlebar padding, weightlifting (Valsalva), and an improperly tacked horse (saddle, stirrups, etc.). […] After an IM infection the literature suggests that athletes in non-contact sports can return to play in 21 days, while athletes in contact sports can return to play in 30 days.

• #33 ClinMed International Library | Spontaneous Spleen Rupture: An Unusual Involvement of the Spleen in Systemic Lupus Erythematosus | Clinical Medical Reviews and Case Reports |

  http://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-3-096.php?jid=cmrcr

  The involvement of the reticuloendothelial system in systemic lupus erythematosus (SLE) concomitant to the disease activity is highly variable, and well-recognised but spontaneous splenic rupture is an unusual occurrence. […] Knowledge of this condition allows the identification of risk factors and the patients characteristics with this rare disease; and can help in early diagnosis and proper treatment. […] The clinical spectrum of patients with SLE is highly variable. The involvement of the reticuloendothelial system is a well-recognized concomitant of the disease. However, it is usually mild, its course is independent of other disease manifestations, and it is not useful as a little use as a prognosis marker. Spontaneous non-traumatic rupture is extremely rare and has been associated as an unusual event in patients with SLE and so far, only six cases have been reported in the literature.

• #34 ClinMed International Library | Spontaneous Spleen Rupture: An Unusual Involvement of the Spleen in Systemic Lupus Erythematosus | Clinical Medical Reviews and Case Reports |

  http://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-3-096.php?jid=cmrcr

  Splenic rupture in the absence of trauma, called spontaneous splenic rupture, is a rare complication of infectious, haematological and neoplastic disorders. […] SLE is a multisystem disease and its clinical manifestations vary according to the organs involved. […] The immune system functions are closely linked to the spleen. Involvement of the reticuloendothelial system in SLE is a well-recognized and can present with lymphadenopathy and splenomegaly, abscesses, abnormal spleen function, histological abnormalities, capsulitis, infarction, and spontaneous rupture. Its reported frequency varies widely, from 9% to 46%. However spontaneous spleen rupture is an extremely rare complication. […] Because of its rare occurrence, the clinical and pathophysiologic factors that may predispose the spleen to spontaneous rupture have not been defined. It continues to pose a diagnostic challenge and dilemma in management. Then, knowledge of this condition allows the identification of risk factors and the patients characteristics with this rare disease. The survival of these patients seems to be uncertain and an early diagnosis may be the only way to a proper and effective treatment improving survival.

• #35 Exploratory Laparotomy and Splenectomy for Ruptured Spleen Following Blunt Force Trauma | Journal of Medical Insight

  https://jomi.com/article/299.9/exploratory-laparotomy-and-splenectomy-for-ruptured-spleen-following-blunt-force-trauma

  The spleen is highly vascular, is the largest secondary lymphoid organ, and is the most commonly injured organ in the setting of blunt abdominal trauma. […] The spleen, which is typically located in the left upper quadrant, is one of the most commonly injured organs in blunt abdominal trauma, occurring in a quarter of blunt abdominal trauma cases and in 2.7% of all traumatic injuries. […] The specific mortality after a splenic injury is 5.4%. […] Operative intervention in the form of splenectomy to stop intra-abdominal bleeding is indicated for high-grade splenic injuries and hemodynamic instability. […] The treatment of splenic injuries is in large part guided by patient condition and the severity of injury. […] Indications for exploratory laparotomy and splenectomy as in the case described include patients who present with hemodynamic instability, which is associated with higher grades (IV, V) of splenic injuries, or the 45% of patients who fail initial nonoperative therapy.

• #36 Spontaneous Rupture of the Spleen: A Case Report and Review of the Literature

  https://www.ej-med.org/index.php/ejmed/article/view/2147

  Non-traumatic ruptures of the spleen are rare, difficult to diagnose and potentially fatal. […] Mortality in this condition is essentially linked to delays in diagnosis and treatment, as well as to risks associated with the terrain and severity of the underlying pathology. […] Spontaneous splenic rupture is a rare disease that was first documented in the 19th century. […] It has a male predominance, and the mean age in the largest series was 45 years, with a mortality rate between 12% and 20%. […] The diagnosis of splenic rupture is challenging. […] Radiology is the key to suggesting the diagnosis; ultrasound is the first imaging to demand its low specificity. […] Management of SSR primarily depends on the patients hemodynamic stability. […] In the case of splenectomy, post-operative care is important. […] Spontaneous rupture of the spleen is a rare entity whose diagnosis is difficult in the absence of a traumatic context and can be life-threatening.

• #37 JCPSP | Journal of College of Physicians and Surgeons Pakistan

  https://www.jcpsp.pk/article-detail/pdelayed-splenic-rupture-due-to-an-occult-primary-injuryorp

  Spleen, due to its unique position and relative mobility, is the most vulnerable organ in blunt abdominal injuries. […] Delayed splenic rupture is ascribed to minor falls that lead to splenic rupture 48 hours after the initial injury and is associated with high mortality. […] Regular monitoring and careful observation are required for early detection of this grave complication. […] Delayed splenic rupture is an uncommon complication of conservative management of splenic injury and is associated with a high mortality rate of 5-15% as compared to that of 1% in acute splenic injuries. […] A number of mechanisms have been described to explain the mechanism of delayed rupture. […] A hemodynamically unstable patient with splenic injury presents with tachycardia and other signs of shock.

• #38 Grade IV splenic injury: When to consult interventional radiology-a case report and review of management protocols

  https://www.ijgii.org/journal/view.html?uid=460&vmd=Full

  The spleen is one of the organs most commonly affected by blunt abdominal trauma. […] Splenic trauma may lead to delayed post-traumatic splenic rupture, which carries a significantly higher mortality rate. […] Computed tomography (CT) is the standard method for grading splenic injuries according to the American Association for the Surgery of Trauma (AAST) splenic injury scale. […] The incidence of delayed splenic rupture is approximately 1%, typically occurring between 4 and 8 days post-injury. […] The significance of delayed splenic rupture is underscored by its substantially higher mortality rate of 5%15%, compared to the 1% overall mortality associated with acute splenic injuries. […] Angioembolization is a critical element of NOM, and the time elapsed from injury to intervention is crucial.

• #39

  https://smw.ch/index.php/smw/article/view/3337

  BACKGROUND: Epstein-Barr virus (EBV), also known as human herpesvirus 4, is one of the most common pathogenic viruses in humans. EBV mononucleosis always involves the spleen and as such it predisposes to splenic rupture, often without a trauma, and splenic infarction. […] In the literature, we found 171 articles published since 1970, documenting 186 cases with splenic rupture and 29 with infarction. […] Approximately 80% (n = 139) of cases occurred within three weeks of the onset of mononucleosis symptoms. […] The mortality rate of splenic rupture was 4.8% (n = 9). […] Similarly to traumatic splenic rupture, splenic preservation is increasingly common in the management of mononucleosis-associated cases as well. This complication is still occasionally fatal. Splenic infarction often occurs in subjects with a pre-existing haematological condition.

• #40 Optimal surveillance and treatment of renal and splenic artery aneurysms | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/12/755

  The risk of rupture is 2% to 10%, with a mortality rate of 25%, and both figures are markedly higher in pregnancy. […] If intervention is not planned, surveillance is recommended at 6 months after diagnosis and then annually. […] In the absence of guidelines, the main recommended indications for intervention of splenic artery aneurysm are rupture, aneurysm size larger than 2 or 2.5 cm, growth of the aneurysm by 3 to 5 mm or more during surveillance regardless of initial size, symptoms, women of childbearing age, portal hypertension, and planned liver transplant.

• #41 The prevalence of early contained vascular injury of spleen | Scientific Reports

  https://www.nature.com/articles/s41598-024-58626-2

  Contained vascular injuries (CVI) of spleen include pseudoaneurysms (PSA) and arterio-venous fistulae (AV-fistulae), and their reported prevalence varies. […] The prevalence of early splenic CVI in patients with a splenic trauma was 8.3-14.5% (95% CI 5.2-22.0%). […] The major aim in this study was to find out the prevalence of early splenic CVI seen on admission CT in a single trauma center’s large unselected material of consecutive patients. […] In our nine-year series we found a total of 20 patients with splenic CVIs. This yields a prevalence of 8.3%, which is slightly higher than previously reported early splenic CVI prevalence of 3.7-4.7%. […] It is known that the CT diagnosis of CVI is protocol dependent. […] This is also seen in our study, as 18 out of 20 CVIs were found when both arterial and venous phase was used.

• #42 The prevalence of early contained vascular injury of spleen | Scientific Reports

  https://www.nature.com/articles/s41598-024-58626-2

  The prevalence was 14.5% when this protocol was used. […] Delayed splenic CVI, PSA in particular, is not uncommon with a prevalence of 3-20%. […] In a large multi-center study based on radiology reports and medical charts, CVI was reported in 20% of the patients with blunt splenic trauma. […] The primary limitation of this study is the retrospective study design from a single trauma center. […] In conclusion, the prevalence of early splenic CVI in patients with splenic trauma was 8.3-14.5% (95% CI 5.2-22.0%). Our data suggests that both arterial and venous phase are needed for CT diagnosis.

• #43 The prevalence of early contained vascular injury of spleen | Scientific Reports

  https://www.nature.com/articles/s41598-024-58626-2

  The prevalence was 14.5% when this protocol was used. […] Delayed splenic CVI, PSA in particular, is not uncommon with a prevalence of 3-20%. […] In a large multi-center study based on radiology reports and medical charts, CVI was reported in 20% of the patients with blunt splenic trauma. […] The primary limitation of this study is the retrospective study design from a single trauma center. […] In conclusion, the prevalence of early splenic CVI in patients with splenic trauma was 8.3-14.5% (95% CI 5.2-22.0%). Our data suggests that both arterial and venous phase are needed for CT diagnosis.

• #44 Splenic trauma: WSES classification and guidelines for adult and pediatric patients | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0151-4

  The WSES position paper suggested to group splenic injury into minor, moderate, and severe. […] The classification considers the AAST-OIS classification and the hemodynamic status and is the same for adult and pediatric patients. […] Based on the present classification, WSES suggests two management algorithms for both adult and pediatric patients explained in Figs. 2 and 3. […] NOM is considered the gold standard for the treatment of patients with blunt splenic trauma (BST) who are hemodynamically stable after an initial resuscitation, in the absence of peritonitis and associated injuries requiring laparotomy. […] 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.

• #45 Grade IV splenic injury: When to consult interventional radiology-a case report and review of management protocols

  https://www.ijgii.org/journal/view.html?uid=460&vmd=Full

  The spleen is one of the organs most commonly affected by blunt abdominal trauma. […] Splenic trauma may lead to delayed post-traumatic splenic rupture, which carries a significantly higher mortality rate. […] Computed tomography (CT) is the standard method for grading splenic injuries according to the American Association for the Surgery of Trauma (AAST) splenic injury scale. […] The incidence of delayed splenic rupture is approximately 1%, typically occurring between 4 and 8 days post-injury. […] The significance of delayed splenic rupture is underscored by its substantially higher mortality rate of 5%15%, compared to the 1% overall mortality associated with acute splenic injuries. […] Angioembolization is a critical element of NOM, and the time elapsed from injury to intervention is crucial.

• #46 Splenic trauma: WSES classification and guidelines for adult and pediatric patients | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0151-4

  The WSES position paper suggested to group splenic injury into minor, moderate, and severe. […] The classification considers the AAST-OIS classification and the hemodynamic status and is the same for adult and pediatric patients. […] Based on the present classification, WSES suggests two management algorithms for both adult and pediatric patients explained in Figs. 2 and 3. […] NOM is considered the gold standard for the treatment of patients with blunt splenic trauma (BST) who are hemodynamically stable after an initial resuscitation, in the absence of peritonitis and associated injuries requiring laparotomy. […] 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.

• #47 Splenic trauma: WSES classification and guidelines for adult and pediatric patients | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0151-4

  The WSES position paper suggested to group splenic injury into minor, moderate, and severe. […] The classification considers the AAST-OIS classification and the hemodynamic status and is the same for adult and pediatric patients. […] Based on the present classification, WSES suggests two management algorithms for both adult and pediatric patients explained in Figs. 2 and 3. […] NOM is considered the gold standard for the treatment of patients with blunt splenic trauma (BST) who are hemodynamically stable after an initial resuscitation, in the absence of peritonitis and associated injuries requiring laparotomy. […] 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.

• #48 Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00457-5

  In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. […] In western countries, 90-85% of traumatic splenic injury patients receive NOM, while the remainder has an immediate splenectomy for hemorrhagic shock or hemodynamic instability. Current data suggest NOM has a success rate of up to 95%. […] As splenic injuries can be fatal not only at the admission of the patient to the Emergency Department (ED) but also due to delayed splenic hematoma or PSA rupture, standardized recommendations in the follow-up of splenic trauma patients treated with NOM are necessary. […] The panel suggests that early discharge after NOM for blunt splenic injury, especially those with WSES Classes IIIII (AAST Grade III), could be at least accompanied by an explicit patient and caregiver education regarding the risk of outpatient rupture and, in every case, an outpatient clinical follow-up, telephone, GP-follow-up, or community nurse follow-up after 5-7 days is recommended.

• #49 Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00457-5

  The panel suggests repeating imaging with contrast-enhanced ultrasound (CEUS)/CT scan in 48-72 h post-admission and, eventually, at 5-7 days of trauma (only if remarkable changes in CT scan at 72 h are detected, or new signs/symptoms related to the trauma occur) in adult patients with WSES Class II splenic injuries (AAST Grade III) or higher treated with NOM, regardless of whether SAE has been performed or not. […] The panel suggests against routine vaccination for OPSI from encapsulated bacteria in patients treated with NOM for splenic injury with or without SAE in favor of a tailored approach that considers the possible effects of losing 50% or more of spleen mass. […] The panel suggests major activity restrictions (athletic activities, no-contact sports, heavy lifting) for 3-5 weeks in low-grade splenic injuries (WSES Class I, AAST Grades III) and up to 2-4 months in high-grade injuries (WSES Classes IIIII, AAST Grades IIIV).

• #50 Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00457-5

  In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. […] In western countries, 90-85% of traumatic splenic injury patients receive NOM, while the remainder has an immediate splenectomy for hemorrhagic shock or hemodynamic instability. Current data suggest NOM has a success rate of up to 95%. […] As splenic injuries can be fatal not only at the admission of the patient to the Emergency Department (ED) but also due to delayed splenic hematoma or PSA rupture, standardized recommendations in the follow-up of splenic trauma patients treated with NOM are necessary. […] The panel suggests that early discharge after NOM for blunt splenic injury, especially those with WSES Classes IIIII (AAST Grade III), could be at least accompanied by an explicit patient and caregiver education regarding the risk of outpatient rupture and, in every case, an outpatient clinical follow-up, telephone, GP-follow-up, or community nurse follow-up after 5-7 days is recommended.

• #51 Splenic trauma: WSES classification and guidelines for adult and pediatric patients | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0151-4

  The WSES position paper suggested to group splenic injury into minor, moderate, and severe. […] The classification considers the AAST-OIS classification and the hemodynamic status and is the same for adult and pediatric patients. […] Based on the present classification, WSES suggests two management algorithms for both adult and pediatric patients explained in Figs. 2 and 3. […] NOM is considered the gold standard for the treatment of patients with blunt splenic trauma (BST) who are hemodynamically stable after an initial resuscitation, in the absence of peritonitis and associated injuries requiring laparotomy. […] 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.

• #52 Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00457-5

  The panel suggests repeating imaging with contrast-enhanced ultrasound (CEUS)/CT scan in 48-72 h post-admission and, eventually, at 5-7 days of trauma (only if remarkable changes in CT scan at 72 h are detected, or new signs/symptoms related to the trauma occur) in adult patients with WSES Class II splenic injuries (AAST Grade III) or higher treated with NOM, regardless of whether SAE has been performed or not. […] The panel suggests against routine vaccination for OPSI from encapsulated bacteria in patients treated with NOM for splenic injury with or without SAE in favor of a tailored approach that considers the possible effects of losing 50% or more of spleen mass. […] The panel suggests major activity restrictions (athletic activities, no-contact sports, heavy lifting) for 3-5 weeks in low-grade splenic injuries (WSES Class I, AAST Grades III) and up to 2-4 months in high-grade injuries (WSES Classes IIIII, AAST Grades IIIV).

• #53 Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00457-5

  The panel suggests repeating imaging with contrast-enhanced ultrasound (CEUS)/CT scan in 48-72 h post-admission and, eventually, at 5-7 days of trauma (only if remarkable changes in CT scan at 72 h are detected, or new signs/symptoms related to the trauma occur) in adult patients with WSES Class II splenic injuries (AAST Grade III) or higher treated with NOM, regardless of whether SAE has been performed or not. […] The panel suggests against routine vaccination for OPSI from encapsulated bacteria in patients treated with NOM for splenic injury with or without SAE in favor of a tailored approach that considers the possible effects of losing 50% or more of spleen mass. […] The panel suggests major activity restrictions (athletic activities, no-contact sports, heavy lifting) for 3-5 weeks in low-grade splenic injuries (WSES Class I, AAST Grades III) and up to 2-4 months in high-grade injuries (WSES Classes IIIII, AAST Grades IIIV).

• #54 Splenic Injury | Korey Stringer Institute

  https://koreystringer.institute.uconn.edu/splenic-injury/

  Splenic rupture occurs when the spleen is placed under intense pressure/duress, strong enough to tear or separate the outer lining of the organ. A ruptured spleen accounts for 10% of all abdominal injuries. […] Often, an athlete returning to contact sports following infectious mononucleosis are at potential risk of splenic rupture secondary to abdominal trauma. […] A splenic rupture is considered a medical emergency, both to repair/save the organ, and to limit the loss of blood from the cardiovascular system. […] It is important that individuals who have been recently diagnosed with IM meet with their doctor for clearance to return to sports. Premature return to sports with an enlarged spleen puts an individual at an increased risk for splenic rupture. […] If this condition is suspected, continue to monitor the athlete for hours after the incident to see if signs or symptoms do occur. Some cases of delayed presentations show symptoms at 40 days post blunt force trauma. […] Once released from hospital, the athlete will need to follow gradual return to play over course of 2 or 3 weeks to allow healing of organ epithelial tissue.

• #55 SPLEEN INJURIES | Sports Medicine Today

  https://www.sportsmedtoday.com/spleen-injuries-va-237.htm

  Spleen injuries in athletes are rare, but potentially life-threatening if missed. […] Splenomegaly is found in 50-60% of patients with IM, and splenic rupture occurs in approximately 1-2 in 1000 of these patients. […] Seventy percent of splenic ruptures in patients with IM are males under 30 years old. […] Some risks that increase the chance of splenic injury include a current or recent diagnosis of IM, participation in contact sports, mountain climbing, skiing, bicycles without handlebar padding, weightlifting (Valsalva), and an improperly tacked horse (saddle, stirrups, etc.). […] After an IM infection the literature suggests that athletes in non-contact sports can return to play in 21 days, while athletes in contact sports can return to play in 30 days.

• #56 Splenic trauma: WSES classification and guidelines for adult and pediatric patients | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0151-4

  Spleen injuries are among the most frequent trauma-related injuries. […] The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. […] The management of splenic trauma has changed considerably in the last few decades especially in favor of non-operative management (NOM). […] These considerations were carried out considering the immunological function of the spleen and the high risk of immunological impairment in splenectomized patients. […] For these reasons, standardized guidelines in the management of splenic trauma are necessary. […] The existing classification of splenic trauma considered the anatomical lesions. […] Trauma management must be multidisciplinary and requires an assessment of both the anatomical injury and its physiologic effects.

• #57

  https://www.aast.org/resources-detail/8764001f-b3b2-425e-89c5-5284d417de1e

  Splenic injuries, whether from penetrating trauma, such as a gunshot or knife wound, or from blunt trauma via motor vehicle crash or fall, are common and can be lethal. […] Blunt splenic trauma management has evolved significantly over the last few decades and as our understanding of the injury and its evolution improves so does our ability to manage the splenic injury whether it’s nonoperatively or surgically.

• #58 Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00457-5

  In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. […] In western countries, 90-85% of traumatic splenic injury patients receive NOM, while the remainder has an immediate splenectomy for hemorrhagic shock or hemodynamic instability. Current data suggest NOM has a success rate of up to 95%. […] As splenic injuries can be fatal not only at the admission of the patient to the Emergency Department (ED) but also due to delayed splenic hematoma or PSA rupture, standardized recommendations in the follow-up of splenic trauma patients treated with NOM are necessary. […] The panel suggests that early discharge after NOM for blunt splenic injury, especially those with WSES Classes IIIII (AAST Grade III), could be at least accompanied by an explicit patient and caregiver education regarding the risk of outpatient rupture and, in every case, an outpatient clinical follow-up, telephone, GP-follow-up, or community nurse follow-up after 5-7 days is recommended.

• #59 Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00457-5

  In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. […] In western countries, 90-85% of traumatic splenic injury patients receive NOM, while the remainder has an immediate splenectomy for hemorrhagic shock or hemodynamic instability. Current data suggest NOM has a success rate of up to 95%. […] As splenic injuries can be fatal not only at the admission of the patient to the Emergency Department (ED) but also due to delayed splenic hematoma or PSA rupture, standardized recommendations in the follow-up of splenic trauma patients treated with NOM are necessary. […] The panel suggests that early discharge after NOM for blunt splenic injury, especially those with WSES Classes IIIII (AAST Grade III), could be at least accompanied by an explicit patient and caregiver education regarding the risk of outpatient rupture and, in every case, an outpatient clinical follow-up, telephone, GP-follow-up, or community nurse follow-up after 5-7 days is recommended.

• #60 Splenic trauma: WSES classification and guidelines for adult and pediatric patients | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0151-4

  NOM failure rate is reported to be between 4 and 15%. […] Strong evidence exists that age above 55-years old, high ISS, and moderate to severe splenic injuries are prognostic factors for NOM failure. […] NOM is recommended as first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma. […] The vast majority of pediatric patients do not require AG/AE for CT blush or moderate to severe injuries. […] AG/AE may be considered in patients undergone to NOM, hemodynamically stable with sings of persistent hemorrhage not amenable of NOM, regardless the presence of CT blush once excluded extra-splenic source of bleeding. […] The management of spleen trauma must be multidisciplinary and must keep into consideration the physiological and anatomical derangement together with the immunological effects.

• #61 Splenic trauma: WSES classification and guidelines for adult and pediatric patients | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0151-4

  NOM failure rate is reported to be between 4 and 15%. […] Strong evidence exists that age above 55-years old, high ISS, and moderate to severe splenic injuries are prognostic factors for NOM failure. […] NOM is recommended as first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma. […] The vast majority of pediatric patients do not require AG/AE for CT blush or moderate to severe injuries. […] AG/AE may be considered in patients undergone to NOM, hemodynamically stable with sings of persistent hemorrhage not amenable of NOM, regardless the presence of CT blush once excluded extra-splenic source of bleeding. […] The management of spleen trauma must be multidisciplinary and must keep into consideration the physiological and anatomical derangement together with the immunological effects.

• #62 An update on nonoperative management of the spleen in adults | Trauma Surgery & Acute Care Open

  https://tsaco.bmj.com/content/2/1/e000075

  Several studies have shown that high-grade injuries or large amounts of hemoperitoneum are associated with higher failure rates of nonoperative management of the spleen. […] The presence, number, and size of these vascular abnormalities make a difference in splenic outcomes as reports indicate an 11% to 40% greater failure rate compared with those injured spleens without such abnormalities. […] Angioembolization has evolved to become an important diagnostic and therapeutic tool for splenic salvage. […] The high association between vascular abnormalities identified on the initial CT scan and the need for subsequent splenectomy justifies the liberal use of angiography in the assessment of these patients. […] Overall, many splenectomies occur within 48 hours of admission and the decision to operate is based on the patients hemodynamic instability or abnormal physical examination findings.

• #63 Splenic Artery Embolization: Proximal or Distal? – Endovascular Today

  https://evtoday.com/articles/2018-apr/splenic-artery-embolization-proximal-or-distal

  The spleen is a fragile organ prone to traumatic rupture and bleeding with potential life-threatening consequences. […] Nonoperative management of splenic rupture is increasingly performed to salvage the spleen, resulting in improved patient immunity. […] Splenic embolization has been shown to increase the success rate of nonoperative management. […] Splenic embolization should be performed in patients with high-grade splenic injury (American Association for the Surgery of Trauma grade IVV), those with American Association for the Surgery of Trauma grade III splenic laceration when a large hemoperitoneum is present, and in those with any vascular splenic injury such as contrast extravasation, vessel rupture, parenchymal blush, or pseudoaneurysm. […] Earlier studies have demonstrated that splenic artery embolization in patients with blunt splenic trauma significantly reduces the risk of splenectomy by up to 18%.

• #64 Splenic Artery Embolization: Proximal or Distal? – Endovascular Today

  https://evtoday.com/articles/2018-apr/splenic-artery-embolization-proximal-or-distal

  A spleen salvage rate of 91% was reported for nonoperative management with splenic artery embolization. […] Two large meta-analyses by Rong et al and Schnriger et al evaluated splenic embolization methods and included 876 and 479 patients, respectively. […] The success rate was higher for proximal splenic artery embolization, but it was not significantly different from distal embolization. […] Nonoperative, organ-preserving management is increasingly being performed in patients with blunt splenic trauma. Splenic artery embolization has shown increased success rates and reduced rates for secondary splenectomy in patients with high-grade splenic trauma.

• #65 Splenic Artery Embolization: Proximal or Distal? – Endovascular Today

  https://evtoday.com/articles/2018-apr/splenic-artery-embolization-proximal-or-distal

  A spleen salvage rate of 91% was reported for nonoperative management with splenic artery embolization. […] Two large meta-analyses by Rong et al and Schnriger et al evaluated splenic embolization methods and included 876 and 479 patients, respectively. […] The success rate was higher for proximal splenic artery embolization, but it was not significantly different from distal embolization. […] Nonoperative, organ-preserving management is increasingly being performed in patients with blunt splenic trauma. Splenic artery embolization has shown increased success rates and reduced rates for secondary splenectomy in patients with high-grade splenic trauma.

• #66 Splenic laceration after routine colonoscopy, a case report of a rare iatrogenic complication – Li – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/3753/html

  Endoscopists and other clinical providers involved in patient care should have a high index of suspicion for splenic injury, particularly with a constellation of left upper quadrant pain and hemodynamic instability. […] Contrast-enhanced CT is the ideal test for diagnosis of splenic trauma. This modality is readily available in most hospital settings and allows for rapid diagnosis and grading of splenic injury. […] Treatment depends on the severity of the splenic injury. Patients with normal blood pressure and hematocrit, a lower grade of splenic injury and low quantity of hemoperitoneum perform better with conservative non-operative/non-interventional approach.

• #67 Spontaneous Splenic Rupture Following Bouts of Coughing: A Rare Case Report and Literature Review | Biswas | Journal of Current Surgery

  https://www.currentsurgery.org/index.php/jcs/article/view/308/279

  CT scan is presently the imaging tool of choice and shows the splenic hematoma or rupture. It has a high sensitivity and specificity in the 95% range in detecting splenic injury. […] Splenectomy remains the choice of treatment in patients presenting in hemorrhagic shock and hemodynamically unstable patients. […] Hemodynamically stable patients can be observed in a monitored setting with serial abdominal exam and labs, bed rest and administration of fluid and blood as required. […] In conclusion, many patients present to the ED with abdominal pain. The possibility of splenic rupture should be considered even in the non-traumatic patient. The delay in diagnosis can be catastrophic.

• #68 Spontaneous Splenic Rupture Following Bouts of Coughing: A Rare Case Report and Literature Review | Biswas | Journal of Current Surgery

  https://www.currentsurgery.org/index.php/jcs/article/view/308/279

  CT scan is presently the imaging tool of choice and shows the splenic hematoma or rupture. It has a high sensitivity and specificity in the 95% range in detecting splenic injury. […] Splenectomy remains the choice of treatment in patients presenting in hemorrhagic shock and hemodynamically unstable patients. […] Hemodynamically stable patients can be observed in a monitored setting with serial abdominal exam and labs, bed rest and administration of fluid and blood as required. […] In conclusion, many patients present to the ED with abdominal pain. The possibility of splenic rupture should be considered even in the non-traumatic patient. The delay in diagnosis can be catastrophic.

• #69 Ruptured spleen: Symptoms, treatment, and causes

  https://www.medicalnewstoday.com/articles/192110

  The most common cause of splenic rupture is blunt trauma to the abdomen. […] The spleen is the abdominal organ that is most at risk during blunt trauma injury. […] Doctors diagnose a ruptured spleen by examining the abdomen and using either an ultrasound or CT scan, depending on the condition of the individual. […] Surgery to remove the spleen is not always necessary. Observation and conservative treatment may be appropriate for some people. […] The spleen is the abdominal organ to which it is most likely an injury will occur during physical trauma. […] Emergency doctors are trained to suspect a ruptured spleen in any person involved in an accident that might have caused injury to their left-lower chest or left-upper abdomen. […] A FAST ultrasound enables clinicians to scan for fluid in four areas of the abdomen, including the space around the spleen. […] The grading of a ruptured spleen helps doctors determine whether surgical or non-operative management is indicated for treatment.

• #70 Splenic Rupture: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/432823-overview

  Determining the actual frequency of splenic injuries with precision in the United States or worldwide is not possible. Hospital discharge data may not document the injury if there are numerous, more serious injuries or diseases. A general consensus of trauma admissions at Level 1 trauma centers across the country suggests splenic injury occurs in as many as 25% of the average 800-1200 admissions for blunt trauma per year. This is a select population of patients with multiple injuries and does not take into account isolated splenic injuries observed and treated at nontrauma centers. […] A thorough knowledge of splenic function, anatomy, and pathophysiology is necessary to continue the progress of the last decade and to decrease the mortality rate from this common injury in the United States and worldwide.

• #71 Splenic Rupture: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/432823-overview

  Determining the actual frequency of splenic injuries with precision in the United States or worldwide is not possible. Hospital discharge data may not document the injury if there are numerous, more serious injuries or diseases. A general consensus of trauma admissions at Level 1 trauma centers across the country suggests splenic injury occurs in as many as 25% of the average 800-1200 admissions for blunt trauma per year. This is a select population of patients with multiple injuries and does not take into account isolated splenic injuries observed and treated at nontrauma centers. […] A thorough knowledge of splenic function, anatomy, and pathophysiology is necessary to continue the progress of the last decade and to decrease the mortality rate from this common injury in the United States and worldwide.

• #72 Splenic laceration after routine colonoscopy, a case report of a rare iatrogenic complication – Li – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/3753/html

  Given the estimated colonoscopy performed, this extrapolates to an annual incidence of at least 224 cases of splenic injury in the United States alone if we assume an incidence rate of 1 in 100,000. Yet, only 172 cases have been reported in the medical literature to date. This suggests the majority of splenic injuries resulting from colonoscopy may be undetected or not reported. […] Overall, splenic injury from colonoscopy is more prevalent in women with a near 3 to 1 ratio for unknown reasons. […] Advanced age is proposed to be a possible risk factor for splenic injury, with average age of occurrence of 63.0 years. However, this may be less of a risk factor, but rather an indicator of the patient population undergoing colonoscopies. […] The mechanisms of injury are proposed to be traction on the splenocolic ligament and/or due to adhesions between the splenic flexure and the spleen in patients with prior abdominal surgery.

• #73 Splenic laceration after routine colonoscopy, a case report of a rare iatrogenic complication – Li – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/3753/html

  Given the estimated colonoscopy performed, this extrapolates to an annual incidence of at least 224 cases of splenic injury in the United States alone if we assume an incidence rate of 1 in 100,000. Yet, only 172 cases have been reported in the medical literature to date. This suggests the majority of splenic injuries resulting from colonoscopy may be undetected or not reported. […] Overall, splenic injury from colonoscopy is more prevalent in women with a near 3 to 1 ratio for unknown reasons. […] Advanced age is proposed to be a possible risk factor for splenic injury, with average age of occurrence of 63.0 years. However, this may be less of a risk factor, but rather an indicator of the patient population undergoing colonoscopies. […] The mechanisms of injury are proposed to be traction on the splenocolic ligament and/or due to adhesions between the splenic flexure and the spleen in patients with prior abdominal surgery.

• #74 Follow-up strategy for early detection of delayed pseudoaneurysms in patients with blunt traumatic spleen injury: A single-center retrospective study

  https://www.wjgnet.com/1948-9366/full/v16/i10/3163.htm

  The spleen is the most commonly injured solid organ in blunt abdominal trauma, and splenic pseudoaneurysm rupture is associated with a high risk of mortality. […] Nonoperative management has become the standard treatment for hemodynamically stable patients with splenic injuries. […] Delayed splenic pseudoaneurysms can develop in any patient, and at present, there are no known risk factors that may reliably predict their occurrence. […] We recommend regular follow-up computed tomography scans, including an arterial and portal venous phase, at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.

• #75 Follow-up strategy for early detection of delayed pseudoaneurysms in patients with blunt traumatic spleen injury: A single-center retrospective study

  https://www.wjgnet.com/1948-9366/full/v16/i10/3163.htm

  The spleen is the most commonly injured solid organ in blunt abdominal trauma, and splenic pseudoaneurysm rupture is associated with a high risk of mortality. […] Nonoperative management has become the standard treatment for hemodynamically stable patients with splenic injuries. […] Delayed splenic pseudoaneurysms can develop in any patient, and at present, there are no known risk factors that may reliably predict their occurrence. […] We recommend regular follow-up computed tomography scans, including an arterial and portal venous phase, at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.

• #76 Follow-up strategy for early detection of delayed pseudoaneurysms in patients with blunt traumatic spleen injury: A single-center retrospective study

  https://www.wjgnet.com/1948-9366/full/v16/i10/3163.htm

  The spleen is the most commonly injured solid organ in blunt abdominal trauma, and splenic pseudoaneurysm rupture is associated with a high risk of mortality. […] Nonoperative management has become the standard treatment for hemodynamically stable patients with splenic injuries. […] Delayed splenic pseudoaneurysms can develop in any patient, and at present, there are no known risk factors that may reliably predict their occurrence. […] We recommend regular follow-up computed tomography scans, including an arterial and portal venous phase, at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.

• #77 Abdominal pain is a main manifestation of delayed bleeding after splenic injury in patients receiving non-operative management | Scientific Reports

  https://www.nature.com/articles/s41598-022-24399-9

  Abdominal pain is a main manifestation of delayed bleeding after splenic injury in patients receiving non-operative management. Delayed bleeding is a major issue in patients with high-grade splenic injuries who receive non-operative management (NOM). Close monitoring of patients with high-grade splenic injury receiving NOM is necessary, as this group of patients is at a higher risk of treatment failure. The failure rate of NOM ranges from 16.7 to 25.0%, depending on patient conditions. The timing of NOM failure ranges from hours to weeks after an injury and there are no factors that can be used to predict this accurately. Therefore, identifying the signs and symptoms of bleeding after NOM is important for early detection, early haemostasis, and the prevention of unfavourable outcomes. This study aimed to identify the clinical manifestations of bleeding in patients with a high-grade splenic injury who received NOM. Abdominal pain was the main manifestation of delayed bleeding for patients following discharge from the ICU. This is an important early warning sign of delayed bleeding from a splenic injury, especially as the patient leaves the hospital. Delayed splenic bleeding is unpredictable and may occur within 4 weeks of the injury. The common clinical manifestations of delayed splenic bleeding include tachycardia, hypotension, a decline in haemoglobin levels, and abdominal pain. Emphasising the importance of abdominal pain as an alarming presentation of delayed bleeding can help patients determine when to return to the hospital for timely management.

• #78 Abdominal pain is a main manifestation of delayed bleeding after splenic injury in patients receiving non-operative management | Scientific Reports

  https://www.nature.com/articles/s41598-022-24399-9

  Abdominal pain is a main manifestation of delayed bleeding after splenic injury in patients receiving non-operative management. Delayed bleeding is a major issue in patients with high-grade splenic injuries who receive non-operative management (NOM). Close monitoring of patients with high-grade splenic injury receiving NOM is necessary, as this group of patients is at a higher risk of treatment failure. The failure rate of NOM ranges from 16.7 to 25.0%, depending on patient conditions. The timing of NOM failure ranges from hours to weeks after an injury and there are no factors that can be used to predict this accurately. Therefore, identifying the signs and symptoms of bleeding after NOM is important for early detection, early haemostasis, and the prevention of unfavourable outcomes. This study aimed to identify the clinical manifestations of bleeding in patients with a high-grade splenic injury who received NOM. Abdominal pain was the main manifestation of delayed bleeding for patients following discharge from the ICU. This is an important early warning sign of delayed bleeding from a splenic injury, especially as the patient leaves the hospital. Delayed splenic bleeding is unpredictable and may occur within 4 weeks of the injury. The common clinical manifestations of delayed splenic bleeding include tachycardia, hypotension, a decline in haemoglobin levels, and abdominal pain. Emphasising the importance of abdominal pain as an alarming presentation of delayed bleeding can help patients determine when to return to the hospital for timely management.

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