Materiały źródłowe

• #1 Ruptured spleen – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ruptured-spleen/diagnosis-treatment/drc-20352322

  Treatment for a ruptured spleen will depend on the seriousness of your condition. Severe injuries usually require immediate surgery. […] Many small or moderate-sized injuries to the spleen can heal without surgery. You’re likely to stay in the hospital while your health care team observe your condition and provide nonsurgical care, such as blood transfusions, if necessary. […] You might have periodic follow-up CT scans to check whether your spleen has healed or to determine whether you need surgery. […] Surgery for a ruptured spleen can include: […] Repairing the spleen. Your surgeon might be able to use stitches or other techniques to repair the rupture. […] Removing the spleen, called a splenectomy. People can live without a spleen, but it increases the risk of serious bacterial infections such as sepsis. Your health care provider may recommend vaccinations against meningitis, pneumonia and haemophilus influenza, type b (Hib). Occasionally, you may be prescribed daily oral antibiotics to prevent infections.

• #2 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  Treatment is dependent on the severity and etiology of rupture, as well as the hemodynamic stability of the patient. […] Non-operative treatment is attempted in 60% to 90% of patients with blunt traumatic splenic injuries out of a desire to preserve splenic function. […] A landmark 1968 case-control study on operative vs. non-operative management by Upadhyaya and Simpson suggested that isolated splenic injuries could be safely treated without surgery in children. […] Since that case, multiple studies have demonstrated similar outcomes, and non-operative management is the main management option, particularly in the pediatric population. […] Current success rates of 90% are reported in pediatric populations. […] Interventional radiology may be available at some institutions as a means to perform arterial embolization for large or small vessel injuries with bleeding in stable trauma patients.

• #3 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 optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. […] The management of splenic trauma has changed considerably in the last few decades especially in favor of non-operative management (NOM). NOM ranges from observation and monitoring alone to angiography/angioembolization (AG/AE) with the aim to preserve the spleen and its function, especially in children.

• #4 Splenic Rupture Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

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

  The trend in management of splenic injury continues to favor nonoperative or conservative management. This varies from institution to institution but usually includes patients with stable hemodynamic signs, stable hemoglobin levels over 12-48 hours, minimal transfusion requirements (2 U or less), CT scan injury scale grade of 1 or 2 without a blush, and patients younger than 55 years. […] Surgical therapy is usually reserved for patients with signs of ongoing bleeding or hemodynamic instability. In some institutions, CT scan-assessed grade V splenic injuries with stable vitals may be observed closely without operative intervention, but most patients with these injuries will undergo an exploratory laparotomy for more precise staging, repair, or removal. […] In less emergent situations, splenorrhaphy is the preferred method of surgical care. Multiple techniques are described in the literature, but they all attempt to tamponade active bleeding either by partial resection and selective vessel ligation or by putting external pressure on the spleen via an absorbable mesh bag or sutures.

• #5 Splenic injuries – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/splenic-injuries/

  Splenic injuries range from small lacerations and hematomas to ruptures with significant tissue damage, vascular compromise, and life-threatening bleeding. A ruptured spleen can cause significant intraabdominal bleeding and should be treated as a medical emergency. Treatment depends on injury severity and hemodynamic status. Conservative therapy with observation may suffice for minor injuries, but some patients require angioembolization or surgery. Surgical interventions include splenic salvage procedures, if feasible, or a splenectomy for extensive injuries. […] Management (operative vs. nonoperative) depends on hemodynamic stability at presentation and after initial resuscitation, splenic injury severity, associated injuries, and available resources. […] Nonoperative management (NOM): preferred for hemodynamically stable patients with blunt splenic injuries regardless of grade.

• #6 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  Treatment is dependent on the severity and etiology of rupture, as well as the hemodynamic stability of the patient. […] Non-operative treatment is attempted in 60% to 90% of patients with blunt traumatic splenic injuries out of a desire to preserve splenic function. […] A landmark 1968 case-control study on operative vs. non-operative management by Upadhyaya and Simpson suggested that isolated splenic injuries could be safely treated without surgery in children. […] Since that case, multiple studies have demonstrated similar outcomes, and non-operative management is the main management option, particularly in the pediatric population. […] Current success rates of 90% are reported in pediatric populations. […] Interventional radiology may be available at some institutions as a means to perform arterial embolization for large or small vessel injuries with bleeding in stable trauma patients.

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

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

  Surgery is now avoided in 95 percent of children and 60 percent of adults that have a splenic rupture. […] When surgery is performed, it is still common practice to remove the entire spleen, although less severe cases may allow a surgeon to repair a tear and put pressure on the spleen until the bleeding stops. […] Those in a stable condition may also undergo a procedure called splenic embolization. The procedure aims to stop any bleeding from the spleen. This procedure usually needs to be performed quickly and can help avoid the need to remove the spleen. […] This is known as a splenectomy. It is normally performed during an emergency laparotomy on a person in an unstable condition. […] In some cases of less severe spleen damage, the organ may be salvaged during surgery. Instead of being completely removed, it may be repaired with partial removal, patches, repairs, or staples. There are, however, very limited opportunities for these options.

• #8 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  Treatment is dependent on the severity and etiology of rupture, as well as the hemodynamic stability of the patient. […] Non-operative treatment is attempted in 60% to 90% of patients with blunt traumatic splenic injuries out of a desire to preserve splenic function. […] A landmark 1968 case-control study on operative vs. non-operative management by Upadhyaya and Simpson suggested that isolated splenic injuries could be safely treated without surgery in children. […] Since that case, multiple studies have demonstrated similar outcomes, and non-operative management is the main management option, particularly in the pediatric population. […] Current success rates of 90% are reported in pediatric populations. […] Interventional radiology may be available at some institutions as a means to perform arterial embolization for large or small vessel injuries with bleeding in stable trauma patients.

• #9 Spleen rupture treatment – USZ

  https://www.usz.ch/en/department/traumatology/service/spleen-rupture-treatment/

  There are various treatment options for a ruptured spleen. Which therapy is used depends on the severity of the injury and the amount and type of concomitant injuries. Specialists can often treat a minor injury to the spleen conservatively without surgery. In more severe cases, however, surgical intervention is necessary. […] Sometimes a ruptured spleen can be treated without surgery. Conservative treatment is an option under the following conditions: The circuit is sufficiently stable. It is a blunt and single spleen injury. The spleen capsule is still intact. Appropriate medical supervision and care is possible. […] Treatment without surgery has the advantage that no abdominal incision (laparotomy) is necessary this is associated with some risks, such as infections. Healing also takes longer and you need more time to recover. In addition, the function of the spleen as an immunological organ is preserved.

• #10 Ruptured Spleen: Symptoms, Causes, Treatment

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

  A ruptured spleen always requires medical attention treatment, but treatment options vary depending on the severity of the injury. […] Treatments for a ruptured spleen aim to stop internal bleeding, promote healing, and preserve the spleen’s function. Treatment approaches vary, depending on the severity of the rupture and bleeding. […] Managing the rupture without surgery is the preferred treatment for a ruptured spleen if your vital signs, such as your heart rate and blood pressure, are stable and the rupture is not causing significant internal bleeding. […] Non-operative management of a ruptured spleen generally involves: Observation: You may require a hospital stay so healthcare providers can closely monitor your condition and routinely check for signs of worsening bleeding or complications. Bed rest: You will need to rest and avoid activities that can worsen the splenic injury and increase the risk of more severe bleeding. Medications: You may receive intravenous (IV) fluid medications for pain management as needed.

• #11 Evolution of the Treatment of Splenic Injuries: From Surgery to Non-Operative Management | Cirugía Española (English Edition)

  https://www.elsevier.es/en-revista-cirugia-espanola-english-edition–436-articulo-evolution-treatment-splenic-injuries-from-S2173507717301722

  The spleen is one of the most frequently injured organs in blunt abdominal trauma. In the past decades, the treatment of patients with blunt splenic injury has shifted from operative to non-operative management. […] Non-operative management has showed a decrease in overall mortality and morbidity. […] The aim of non-surgical management in splenic trauma is to preserve function and reduce the morbidity and mortality associated with surgery. It is associated with a lower rate of non-therapeutic laparotomies, lower rate of blood transfusion, reduced overall morbidity and mortality rates, and lower hospital costs. […] Nonsurgical management should include: hospitalization in intermediate or intensive care units with continuous monitoring of vital signs, relative rest, control of hemoglobin levels and a follow-up series of abdominal explorations.

• #12 Ruptured Spleen: Symptoms, Causes, Treatment

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

  A ruptured spleen always requires medical attention treatment, but treatment options vary depending on the severity of the injury. […] Treatments for a ruptured spleen aim to stop internal bleeding, promote healing, and preserve the spleen’s function. Treatment approaches vary, depending on the severity of the rupture and bleeding. […] Managing the rupture without surgery is the preferred treatment for a ruptured spleen if your vital signs, such as your heart rate and blood pressure, are stable and the rupture is not causing significant internal bleeding. […] Non-operative management of a ruptured spleen generally involves: Observation: You may require a hospital stay so healthcare providers can closely monitor your condition and routinely check for signs of worsening bleeding or complications. Bed rest: You will need to rest and avoid activities that can worsen the splenic injury and increase the risk of more severe bleeding. Medications: You may receive intravenous (IV) fluid medications for pain management as needed.

• #13 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 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. […] NOM failure rate is reported to be between 4 and 15%. […] NOM is recommended as first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma. […] NOM should be attempted even in the setting of concomitant head trauma; unless the patient is unstable, and this might be due to intra-abdominal bleeding. […] The presence of contrast blush at CT scan is not an absolute indication for splenectomy or AG/AE in children. […] Patients should undergo to OM in case of hemodynamic instability, failure of conservative treatments, severe coexisting injuries necessitating intervention and peritonitis, bowel evisceration, impalement. […] Splenic preservation (at least partial) should be attempted whenever possible.

• #14 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  This is also an option in patients who fail conservative management. […] Exploratory laparotomy is, however, indicated if continuing hemodynamic instability or if the patient has required more than 4 units of blood during a 48-hour period. […] The initial choice in surgical management is to repair any capsular lacerations (splenorrhaphy). […] If extensive injury or uncontrolled hemorrhage is present, splenectomy is warranted. […] Post-splenectomy vaccinations are intended to address encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides). […] Children who have a splenectomy are generally recommended to take phenoxymethylpenicillin (Pen VK) until they are 5 years old, though the recommended duration of this prophylaxis varies.

• #15 Embolization for Splenic Trauma – Endovascular Today

  https://evtoday.com/articles/2016-apr/embolization-for-splenic-trauma

  Healing the spleen with curative and preventive embolization. […] Until recently, the preferred management of spleen traumas was surgery, but nonoperative management (NOM) is increasingly preferred. NOM increases spleen salvage and thus improves patients immunity to infection (vs those with a compromised immune system due to splenectomy); however, there is a risk of immediate or late bleeding leading to secondary splenectomy. The success rate of NOM may be increased by introducing endovascular treatment into the management strategy, including curative embolization of ongoing bleeding and preventive embolization of high-grade trauma without obvious bleeding lesions. […] The embolization indication is called curative when parenchymal bleeding has to be fixed. […] The indication is called preventive when the goal is to avoid secondary bleeding by decreasing blood pressure into the spleen. […] Embolization has become an important treatment option for the management of splenic trauma, but it needs well-trained radiologists and close follow-up to improve patient outcome.

• #16 Spleen rupture treatment – USZ

  https://www.usz.ch/en/department/traumatology/service/spleen-rupture-treatment/

  The operation is usually performed via an abdominal incision (laparotomy). Trauma surgeons try to preserve the spleen and stop the bleeding using various techniques, especially in children and adolescents. This procedure to stop bleeding is called splenorrhaphy. […] In the case of severe splenic ruptures, parts of the spleen (partial resection) are removed using a laser, ultrasonic scalpel or knife and clamps. Sometimes it is not possible to preserve the organ and the entire spleen (splenectomy) is removed as part of the surgical procedure. […] In selected cases, the supplying vessel (lienal artery) can be closed by means of a catheter inserted from the groin in order to preserve the spleen. This massively reduces the risk of bleeding.

• #17 Embolization for Splenic Trauma – Endovascular Today

  https://evtoday.com/articles/2016-apr/embolization-for-splenic-trauma

  Healing the spleen with curative and preventive embolization. […] Until recently, the preferred management of spleen traumas was surgery, but nonoperative management (NOM) is increasingly preferred. NOM increases spleen salvage and thus improves patients immunity to infection (vs those with a compromised immune system due to splenectomy); however, there is a risk of immediate or late bleeding leading to secondary splenectomy. The success rate of NOM may be increased by introducing endovascular treatment into the management strategy, including curative embolization of ongoing bleeding and preventive embolization of high-grade trauma without obvious bleeding lesions. […] The embolization indication is called curative when parenchymal bleeding has to be fixed. […] The indication is called preventive when the goal is to avoid secondary bleeding by decreasing blood pressure into the spleen. […] Embolization has become an important treatment option for the management of splenic trauma, but it needs well-trained radiologists and close follow-up to improve patient outcome.

• #18 Embolization for Splenic Trauma – Endovascular Today

  https://evtoday.com/articles/2016-apr/embolization-for-splenic-trauma

  Healing the spleen with curative and preventive embolization. […] Until recently, the preferred management of spleen traumas was surgery, but nonoperative management (NOM) is increasingly preferred. NOM increases spleen salvage and thus improves patients immunity to infection (vs those with a compromised immune system due to splenectomy); however, there is a risk of immediate or late bleeding leading to secondary splenectomy. The success rate of NOM may be increased by introducing endovascular treatment into the management strategy, including curative embolization of ongoing bleeding and preventive embolization of high-grade trauma without obvious bleeding lesions. […] The embolization indication is called curative when parenchymal bleeding has to be fixed. […] The indication is called preventive when the goal is to avoid secondary bleeding by decreasing blood pressure into the spleen. […] Embolization has become an important treatment option for the management of splenic trauma, but it needs well-trained radiologists and close follow-up to improve patient outcome.

• #19 JMIR Research Protocols – Quality of Life and Clinical Outcome After Traumatic Spleen Injury (SPLENIQ Study): Protocol for an Observational Retrospective and Prospective Cohort Study

  https://www.researchprotocols.org/2019/5/e12391/

  Background: Little is known about the effect of a splenic rupture on the quality of life (QOL) of patients, although the spleen is one of the most frequently injured organs in blunt abdominal trauma. It is essential to obtain more knowledge about QOL after traumatic spleen injury so that this can be taken into account when choosing treatment. […] Treatment of splenic injury depends on the severity of the splenic injury, the hemodynamic condition of the patient, and the hospitals or doctors preference. […] Presently, the standard of care in hemodynamically stable patients is nonoperative management (NOM), involving close observation of the patient, with success rates up to 90%. […] When NOM fails, angiography and splenic artery embolization (SAE) can be used as a supplement to NOM. The success rate of SAE ranges between 73% and 100%, with an overall success rate of NOM combined with SAE ranging between 86% and 100% (most studies reporting success rates greater than 90%).

• #20 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  The main complications of conservative treatment or embolisation are ongoing bleeding, splenic necrosis, splenic abscess or cyst formation, and thrombocytosis (typically transient). […] All patients with suspect splenic injury should be assessed, resuscitated, and treated according to ATLS principles. Patients who are haemodynamically unstable or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy. […] Splenic artery embolisation by interventional radiology is an important alternative management option, where available, potentially negating the need for laparotomy and preserving splenic function. […] Consideration should be given for prophylactic vaccinations (against Strep Pneumoniae, Haemophilus Influenzae B (HIB) and Meningococcus) and prophylactic antibiotics (against encapsulated bacteria). […] The overall mortality rates of patients presenting to hospital with trauma splenic injury are around 10%.

• #21 Splenic Rupture Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

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

  The trend in management of splenic injury continues to favor nonoperative or conservative management. This varies from institution to institution but usually includes patients with stable hemodynamic signs, stable hemoglobin levels over 12-48 hours, minimal transfusion requirements (2 U or less), CT scan injury scale grade of 1 or 2 without a blush, and patients younger than 55 years. […] Surgical therapy is usually reserved for patients with signs of ongoing bleeding or hemodynamic instability. In some institutions, CT scan-assessed grade V splenic injuries with stable vitals may be observed closely without operative intervention, but most patients with these injuries will undergo an exploratory laparotomy for more precise staging, repair, or removal. […] In less emergent situations, splenorrhaphy is the preferred method of surgical care. Multiple techniques are described in the literature, but they all attempt to tamponade active bleeding either by partial resection and selective vessel ligation or by putting external pressure on the spleen via an absorbable mesh bag or sutures.

• #22 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  This is also an option in patients who fail conservative management. […] Exploratory laparotomy is, however, indicated if continuing hemodynamic instability or if the patient has required more than 4 units of blood during a 48-hour period. […] The initial choice in surgical management is to repair any capsular lacerations (splenorrhaphy). […] If extensive injury or uncontrolled hemorrhage is present, splenectomy is warranted. […] Post-splenectomy vaccinations are intended to address encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides). […] Children who have a splenectomy are generally recommended to take phenoxymethylpenicillin (Pen VK) until they are 5 years old, though the recommended duration of this prophylaxis varies.

• #23 Splenic Rupture | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29383

  Treatment is dependent on the severity and etiology of rupture, as well as the hemodynamic stability of the patient. […] Non-operative treatment is attempted in 60% to 90% of patients with blunt traumatic splenic injuries out of a desire to preserve splenic function. […] A landmark 1968 case-control study on operative vs. non-operative management by Upadhyaya and Simpson suggested that isolated splenic injuries could be safely treated without surgery in children. […] Current success rates of 90% are reported in pediatric populations. […] Interventional radiology may be available at some institutions as a means to perform arterial embolization for large or small vessel injuries with bleeding in stable trauma patients. […] Exploratory laparotomy is, however, indicated if continuing hemodynamic instability or if the patient has required more than 4 units of blood during a 48-hour period.

• #24 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 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. […] NOM failure rate is reported to be between 4 and 15%. […] NOM is recommended as first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma. […] NOM should be attempted even in the setting of concomitant head trauma; unless the patient is unstable, and this might be due to intra-abdominal bleeding. […] The presence of contrast blush at CT scan is not an absolute indication for splenectomy or AG/AE in children. […] Patients should undergo to OM in case of hemodynamic instability, failure of conservative treatments, severe coexisting injuries necessitating intervention and peritonitis, bowel evisceration, impalement. […] Splenic preservation (at least partial) should be attempted whenever possible.

• #25 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  The main complications of conservative treatment or embolisation are ongoing bleeding, splenic necrosis, splenic abscess or cyst formation, and thrombocytosis (typically transient). […] All patients with suspect splenic injury should be assessed, resuscitated, and treated according to ATLS principles. Patients who are haemodynamically unstable or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy. […] Splenic artery embolisation by interventional radiology is an important alternative management option, where available, potentially negating the need for laparotomy and preserving splenic function. […] Consideration should be given for prophylactic vaccinations (against Strep Pneumoniae, Haemophilus Influenzae B (HIB) and Meningococcus) and prophylactic antibiotics (against encapsulated bacteria). […] The overall mortality rates of patients presenting to hospital with trauma splenic injury are around 10%.

• #26 Ruptured spleen – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ruptured-spleen/diagnosis-treatment/drc-20352322

  Treatment for a ruptured spleen will depend on the seriousness of your condition. Severe injuries usually require immediate surgery. […] Many small or moderate-sized injuries to the spleen can heal without surgery. You’re likely to stay in the hospital while your health care team observe your condition and provide nonsurgical care, such as blood transfusions, if necessary. […] You might have periodic follow-up CT scans to check whether your spleen has healed or to determine whether you need surgery. […] Surgery for a ruptured spleen can include: […] Repairing the spleen. Your surgeon might be able to use stitches or other techniques to repair the rupture. […] Removing the spleen, called a splenectomy. People can live without a spleen, but it increases the risk of serious bacterial infections such as sepsis. Your health care provider may recommend vaccinations against meningitis, pneumonia and haemophilus influenza, type b (Hib). Occasionally, you may be prescribed daily oral antibiotics to prevent infections.

• #27 Ruptured spleen: Causes, Symptoms, Treatment and Cost

  https://www.lybrate.com/topic/ruptured-spleen

  Ruptured spleen Treatment, therapy […] Splenectomy: This is a surgical procedure that involves the removal of the spleen. It is the most common treatment for a ruptured spleen. […] Spleen Repair: This surgical procedure involves repairing the damaged spleen with suturing and/or other techniques, such as patching or stitching. The goal of this procedure is to restore normal functioning of the spleen. […] Splenorrhaphy: This surgery involves closing the opening in the spleen using sutures and/or other techniques such as patching or stitching. It is used to treat localized areas of injury, such as a laceration or tear, in the spleen. […] Embolization: This procedure involves blocking off blood vessels that are supplying blood to a ruptured spleen with a small coil or plug in order to stop bleeding and reduce swelling and pain. […] Non-steroidal anti-inflammatory drugs (NSAIDs): They are often used to relieve the pain and inflammation that come along with a spleen that has burst. […] Corticosteroids: These drugs reduce inflammation in the body and can help limit the damage to the spleen caused by a rupture. […] Antibiotics: These are used to prevent and treat any bacterial infections that may develop after a spleen rupture or during surgery to repair the spleen. […] Anti-coagulants: These medications help prevent blood clots from forming in the affected area, which can further damage the spleen or cause other complications. […] Pain relievers: Medications such as codeine and oxycodone may be prescribed to help manage pain associated with a ruptured spleen. […] The amount of time it takes to recover from a ruptured spleen depends on the severity of the injury, whether the spleen was removed and other factors. Generally, recovery can take anywhere from two to six weeks. […] After a ruptured spleen, it is important to rest and reduce physical activities for at least four weeks. This helps the body heal and prevent further injury. […] Pain relief medications are usually prescribed to help manage symptoms from a ruptured spleen. Antibiotics may also be prescribed to help prevent infection. […] To prevent further injury, contact sports such as football and martial arts should be avoided for at least six months after a ruptured spleen. […] Eating a diet high in fibre and low in carbohydrates can help reduce the risk of developing complications from a ruptured spleen, such as constipation or nausea. […] No, the results of treatment for a ruptured spleen are not permanent. The spleen may need to be removed, which will permanently alter the body’s immune system. […] Surgery may be required to repair the damaged spleen, but it is possible for the spleen to rupture again if it is not monitored and cared for properly.

• #28 Splenic Rupture Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

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

  The trend in management of splenic injury continues to favor nonoperative or conservative management. This varies from institution to institution but usually includes patients with stable hemodynamic signs, stable hemoglobin levels over 12-48 hours, minimal transfusion requirements (2 U or less), CT scan injury scale grade of 1 or 2 without a blush, and patients younger than 55 years. […] Surgical therapy is usually reserved for patients with signs of ongoing bleeding or hemodynamic instability. In some institutions, CT scan-assessed grade V splenic injuries with stable vitals may be observed closely without operative intervention, but most patients with these injuries will undergo an exploratory laparotomy for more precise staging, repair, or removal. […] In less emergent situations, splenorrhaphy is the preferred method of surgical care. Multiple techniques are described in the literature, but they all attempt to tamponade active bleeding either by partial resection and selective vessel ligation or by putting external pressure on the spleen via an absorbable mesh bag or sutures.

• #29 Splenic rupture: Information & spleen rupture specialists

  https://www.leading-medicine-guide.com/en/illness/injuries/spleen-rupture

  The conservative approach includes the wait-and-see strategy, in which the patient is monitored, and interventional therapy with angioembolization. […] However, if a patient cannot be stabilized by blood transfusions, surgery is required. […] Splenorrhaphy is a spleen-preserving operation. The surgeon places constricting sutures and embeds the spleen in an absorbable mesh. […] However, if the bleeding cannot be controlled by this or local hemostasis procedures, the spleen must be partially (partial splenectomy) or completely (splenectomy) removed. […] Current medical recommendations suggest the following basic procedure: In the circulatory stable patient with spleen injury without concomitant injuries: Non-surgical treatment. In patients with stable circulation and spleen injury in whom the bleeding does not stop on its own: angioembolization instead of surgery. In the case of a grade 1, 2 or 3 splenic rupture, if surgery is required: Spleen-preserving surgery. In the case of a type 4 or 5 splenic rupture: splenectomy instead of spleen preservation.

• #30 Splenic Injury – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/abdominal-trauma/splenic-injury

  Splenic injury usually results from blunt abdominal trauma. Treatment is with observation and sometimes surgical repair; rarely, splenectomy is necessary. […] In the past, treatment for any splenic injury was splenectomy. However, splenectomy should be avoided if possible, particularly in older patients, children, and patients with hematologic malignancy, to avoid the resulting permanent susceptibility to bacterial infections, increasing the risk of overwhelming postsplenectomy sepsis. […] Currently, most low-grade and many high-grade splenic injuries can be managed nonoperatively, even in patients 55 years. […] Patients with significant ongoing hemorrhage (ie, significant ongoing transfusion requirements and/or declining hematocrit [Hct]) require laparotomy. […] When surgery is needed, hemorrhage can sometimes be controlled by suturing, topical hemostatic agents (eg, oxidized cellulose, thrombin compounds, fibrin glue), or partial splenectomy, but splenectomy is still sometimes necessary.

• #31 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

  Splenic rupture due to trauma is relatively common. However, spontaneous non-traumatic ruptures do occur. […] The therapy of choice can vary between patients depending on the grade of splenic rupture, hemodynamic instability, availability of endovascular treatment and physician preference. Treatment should be focused on preserving splenic tissue if feasible. Non-traumatic rupture of the spleen must be considered in patients presenting with left-sided upper abdominal pain even without evident history of trauma, since early recognition and treatment can prevent serious morbidity and mortality. […] Splenectomy remains the choice of treatment in patients presenting in hemorrhagic shock and hemodynamically unstable patients. During laparotomy repair of the spleen or absorbable mesh encasement (splenorrhaphy) to preserve splenic functions are options depending on the severity and hemodynamic status.

• #32 Ruptured spleen – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ruptured-spleen/diagnosis-treatment/drc-20352322

  Removing part of the spleen. It might be possible to remove only part of your spleen, depending on the rupture. Partial splenectomy reduces the risk of infection that results from removing the entire spleen. […] Spleen surgery is generally safe, but any surgery has risks, such as bleeding, blood clots, infection and pneumonia.

• #33 Spleen rupture treatment – USZ

  https://www.usz.ch/en/department/traumatology/service/spleen-rupture-treatment/

  The operation is usually performed via an abdominal incision (laparotomy). Trauma surgeons try to preserve the spleen and stop the bleeding using various techniques, especially in children and adolescents. This procedure to stop bleeding is called splenorrhaphy. […] In the case of severe splenic ruptures, parts of the spleen (partial resection) are removed using a laser, ultrasonic scalpel or knife and clamps. Sometimes it is not possible to preserve the organ and the entire spleen (splenectomy) is removed as part of the surgical procedure. […] In selected cases, the supplying vessel (lienal artery) can be closed by means of a catheter inserted from the groin in order to preserve the spleen. This massively reduces the risk of bleeding.

• #34 Ruptured spleen // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/ruptured-spleen

  Occasionally, you may be prescribed daily oral antibiotics to prevent infections. […] Removing part of the spleen. It might be possible to remove only part of your spleen, depending on the rupture. Partial splenectomy reduces the risk of infection that results from removing the entire spleen. […] Spleen surgery is generally safe, but any surgery has risks, such as bleeding, blood clots, infection and pneumonia.

• #35 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  This is also an option in patients who fail conservative management. […] Exploratory laparotomy is, however, indicated if continuing hemodynamic instability or if the patient has required more than 4 units of blood during a 48-hour period. […] The initial choice in surgical management is to repair any capsular lacerations (splenorrhaphy). […] If extensive injury or uncontrolled hemorrhage is present, splenectomy is warranted. […] Post-splenectomy vaccinations are intended to address encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides). […] Children who have a splenectomy are generally recommended to take phenoxymethylpenicillin (Pen VK) until they are 5 years old, though the recommended duration of this prophylaxis varies.

• #36 Ruptured spleen – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ruptured-spleen/diagnosis-treatment/drc-20352322

  Treatment for a ruptured spleen will depend on the seriousness of your condition. Severe injuries usually require immediate surgery. […] Many small or moderate-sized injuries to the spleen can heal without surgery. You’re likely to stay in the hospital while your health care team observe your condition and provide nonsurgical care, such as blood transfusions, if necessary. […] You might have periodic follow-up CT scans to check whether your spleen has healed or to determine whether you need surgery. […] Surgery for a ruptured spleen can include: […] Repairing the spleen. Your surgeon might be able to use stitches or other techniques to repair the rupture. […] Removing the spleen, called a splenectomy. People can live without a spleen, but it increases the risk of serious bacterial infections such as sepsis. Your health care provider may recommend vaccinations against meningitis, pneumonia and haemophilus influenza, type b (Hib). Occasionally, you may be prescribed daily oral antibiotics to prevent infections.

• #37 Spleen problems and spleen removal

  https://www.nhs.uk/conditions/spleen-problems-and-spleen-removal/

  Some people are born without a spleen or need to have it removed because of illness or injury. […] A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding. Go straight to AE if you think you have ruptured or damaged your spleen. […] You may need an operation to remove your spleen, known as a splenectomy, if it’s not working properly or it’s damaged, diseased or enlarged. […] Most operations to remove spleens are carried out using keyhole surgery (laparoscopy). […] Open surgery is where one large cut is made. It may be needed if your spleen cannot be removed using keyhole surgery. […] Recovery usually takes a few weeks. Your doctor or nurse will advise when you can go back to your usual activities, such as driving. […] It’s recommended that you take low-dose antibiotics for at least 2 years, and in many cases, the rest of your life, to prevent bacterial infections. […] Healthcare professionals will mark your health records to show that you do not have a working spleen.

• #38 Blunt splenic trauma – Wikipedia

  https://en.wikipedia.org/wiki/Blunt_splenic_trauma

  Treatment has traditionally been splenectomy. Splenectomy involves ligation of three splenic attachments (splenorenal ligament, splenocolic ligament and splenophrenic ligament) to mobilize the spleen. The splenorenal ligament is located laterally, the splenocolic ligament inferiorly and the splenophrenic ligament superiorly. followed by suture ligation of the splenic blood supply. After the spleen has been removed, the abdomen is irrigated with normal saline to confirm hemostasis. After confirmation abdominal organs are put into anatomical position, followed by closure of the abdomen. […] However, splenectomy is avoided if possible, particularly in children, to avoid the resulting permanent susceptibility to bacterial infections. Most small, and some moderate-sized lacerations in stable patients (particularly children) are managed with hospital observation and sometimes transfusion rather than surgery. Embolization, blocking off of the hemorrhaging vessels, is a newer and less invasive treatment. […] When surgery is needed, the spleen can be surgically repaired in a few cases, but splenectomy is still the primary surgical treatment, and has the highest success rate of all treatments.

• #39 Ruptured spleen – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ruptured-spleen/diagnosis-treatment/drc-20352322

  Treatment for a ruptured spleen will depend on the seriousness of your condition. Severe injuries usually require immediate surgery. […] Many small or moderate-sized injuries to the spleen can heal without surgery. You’re likely to stay in the hospital while your health care team observe your condition and provide nonsurgical care, such as blood transfusions, if necessary. […] You might have periodic follow-up CT scans to check whether your spleen has healed or to determine whether you need surgery. […] Surgery for a ruptured spleen can include: […] Repairing the spleen. Your surgeon might be able to use stitches or other techniques to repair the rupture. […] Removing the spleen, called a splenectomy. People can live without a spleen, but it increases the risk of serious bacterial infections such as sepsis. Your health care provider may recommend vaccinations against meningitis, pneumonia and haemophilus influenza, type b (Hib). Occasionally, you may be prescribed daily oral antibiotics to prevent infections.

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

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

  In the case of splenectomy, post-operative care is important. Patients need close monitoring with transfusion. If necessary, vaccination should be given 14 days after the surgery. It may cover pneumococcus, haemophilus influenza and meningococcus. […] 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. Ultrasound and CT scans help to orient the diagnosis, and treatment is essentially surgical by splenectomy.

• #41 Spleen problems and spleen removal

  https://www.nhs.uk/conditions/spleen-problems-and-spleen-removal/

  Some people are born without a spleen or need to have it removed because of illness or injury. […] A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding. Go straight to AE if you think you have ruptured or damaged your spleen. […] You may need an operation to remove your spleen, known as a splenectomy, if it’s not working properly or it’s damaged, diseased or enlarged. […] Most operations to remove spleens are carried out using keyhole surgery (laparoscopy). […] Open surgery is where one large cut is made. It may be needed if your spleen cannot be removed using keyhole surgery. […] Recovery usually takes a few weeks. Your doctor or nurse will advise when you can go back to your usual activities, such as driving. […] It’s recommended that you take low-dose antibiotics for at least 2 years, and in many cases, the rest of your life, to prevent bacterial infections. […] Healthcare professionals will mark your health records to show that you do not have a working spleen.

• #42 Spleen problems and spleen removal | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/spleen-problems-and-spleen-removal/

  The spleen can become damaged or may rupture (burst) after a forceful blow to the abdomen, car accident, sporting accident or fracture to the ribs. […] A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding. […] An operation to remove the spleen, known as a splenectomy, may be needed if the spleen is damaged, diseased or enlarged. […] Most splenectomies are carried out using laparoscopy (keyhole surgery). […] Open surgery, where one large incision is made, may be needed if the spleen is too large or too damaged to be removed via keyhole surgery. […] Its normal to feel sore and be bruised after a splenectomy, but youll be given pain relief medication. […] Recovery usually takes a few weeks. Your doctor or nurse will advise when you can go back to your usual activities, such as driving. […] If your spleen needs to be removed, other organs such as the liver can take over many of the spleens functions. […] Its recommended that you take low-dose antibiotics for the rest of your life to prevent bacterial infections.

• #43 Splenic Rupture | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29383

  The initial choice in surgical management is to repair any capsular lacerations (splenorrhaphy). […] If extensive injury or uncontrolled hemorrhage is present, splenectomy is warranted. […] Post-splenectomy vaccinations are intended to address encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides.). […] Children who have a splenectomy are generally recommended to take phenoxymethylpenicillin (Pen VK) until they are 5 years old, though the recommended duration of this prophylaxis varies.

• #44 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. While surgery is not always necessary, timely treatment is critical. […] Treatment for a ruptured spleen typically falls into two camps: several days of intensive hospital care or surgery. […] If the injury or damage to the spleen is too great, or if doctors are unable to stop the internal bleeding, a splenectomy is often the treatment of choice. In 10% to 15% of patients with a blunt spleen injury, surgical spleen removal is necessary. […] However, in some cases, a more conservative approach is taken. Several days of hospital care and regular testing will be necessary to make sure the injury to the spleen doesn’t worsen. […] With proper treatment and follow-up care, recovery from a ruptured spleen is typically excellent. Some people may be able to recover from a ruptured spleen with hospital care and recovery time. Others may require surgery to remove the damaged spleen. […] If you’ve been injured and have symptoms of a ruptured spleen, seek emergency care right away.

• #45 The Symptoms and Causes of a Ruptured Spleen – The Thistle Law Firm

  https://thistlelaw.com/the-symptoms-and-causes-of-a-ruptured-spleen/

  Most ruptured spleens will require immediate surgery called a splenectomy, in which the surgeon will remove the entire spleen. In some cases, the surgeon may be able to repair the tear and put pressure on the spleen until the bleeding has stopped. […] For those with a minor splenic rupture, the medical team should keep the patient under strict observation, usually in conjunction with active treatment and possible blood transfusions. They should be continually monitored with scans such as a CT scan. […] Most people who experience a ruptured spleen can expect to recover within 3 to 12 weeks. However, some people may take longer to heal, especially if they have had surgery. […] If you have had surgery for a ruptured spleen, you will likely need to stay in the hospital for a few days afterward. During this time, you will be monitored by doctors and nurses to ensure that you are healing properly.

• #46

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abq5896

  Treatment depends on how severe the injury is. Your spleen was not injured badly enough to need to be removed with surgery. Your treatment includes careful observation in the hospital to watch for bleeding. It might also include a procedure to block some blood flow to parts of your spleen. This helps control bleeding while your spleen heals. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. […] Get plenty of rest for 2 to 3 months while your spleen heals. […] Avoid strenuous activities that could re-injure your spleen. These include lifting, jogging, aerobic exercise, and contact sports. […] Ask your doctor before you take aspirin or NSAIDs like ibuprofen. These medicines can make bleeding worse. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if you do not get better as expected.

• #47 Ruptured spleen: Causes, Symptoms, Treatment and Cost

  https://www.lybrate.com/topic/ruptured-spleen

  Ruptured spleen Treatment, therapy […] Splenectomy: This is a surgical procedure that involves the removal of the spleen. It is the most common treatment for a ruptured spleen. […] Spleen Repair: This surgical procedure involves repairing the damaged spleen with suturing and/or other techniques, such as patching or stitching. The goal of this procedure is to restore normal functioning of the spleen. […] Splenorrhaphy: This surgery involves closing the opening in the spleen using sutures and/or other techniques such as patching or stitching. It is used to treat localized areas of injury, such as a laceration or tear, in the spleen. […] Embolization: This procedure involves blocking off blood vessels that are supplying blood to a ruptured spleen with a small coil or plug in order to stop bleeding and reduce swelling and pain. […] Non-steroidal anti-inflammatory drugs (NSAIDs): They are often used to relieve the pain and inflammation that come along with a spleen that has burst. […] Corticosteroids: These drugs reduce inflammation in the body and can help limit the damage to the spleen caused by a rupture. […] Antibiotics: These are used to prevent and treat any bacterial infections that may develop after a spleen rupture or during surgery to repair the spleen. […] Anti-coagulants: These medications help prevent blood clots from forming in the affected area, which can further damage the spleen or cause other complications. […] Pain relievers: Medications such as codeine and oxycodone may be prescribed to help manage pain associated with a ruptured spleen. […] The amount of time it takes to recover from a ruptured spleen depends on the severity of the injury, whether the spleen was removed and other factors. Generally, recovery can take anywhere from two to six weeks. […] After a ruptured spleen, it is important to rest and reduce physical activities for at least four weeks. This helps the body heal and prevent further injury. […] Pain relief medications are usually prescribed to help manage symptoms from a ruptured spleen. Antibiotics may also be prescribed to help prevent infection. […] To prevent further injury, contact sports such as football and martial arts should be avoided for at least six months after a ruptured spleen. […] Eating a diet high in fibre and low in carbohydrates can help reduce the risk of developing complications from a ruptured spleen, such as constipation or nausea. […] No, the results of treatment for a ruptured spleen are not permanent. The spleen may need to be removed, which will permanently alter the body’s immune system. […] Surgery may be required to repair the damaged spleen, but it is possible for the spleen to rupture again if it is not monitored and cared for properly.

• #48 Discharge Instructions: Spleen Injury | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/discharge-instructions-spleen-injury

  The spleen may take up to 3 months to heal. Its important to rest and let it heal. This is to help prevent rupture of the spleen. A ruptured spleen is a life-threatening medical emergency that may result in large amounts of internal bleeding and shock. If the spleen ruptures, immediate surgery is required. […] Follow up with your healthcare provider as advised. You may need imaging tests or blood tests to be sure you are healing well. […] Call your healthcare provider or seek medical care right away if you have any of these:

• #49 Splenic Injury | Korey Stringer Institute

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

  How Do You Treat an Individual With a Splenic Injury? Check and monitor vital signs (Blood Pressure, Pulse, Respiratory Rate). Call 9-1-1, activate EMS. When at the hospital procedures may include: Surgery to repair organ, or remove it completely (splenectomy). Aspiration (removal of pooled blood and swelling). CT Scan (Computed Tomography). Diagnostic Ultrasound. MRI (magnetic resonance imaging). CBC (Complete Blood Count). […] 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. The athlete should be monitored very closely by an Athletic Trainer or sports medicine professional to ensure athlete safety and no return of signs or symptoms.

• #50 Spleen problems and spleen removal

  https://www.nhs.uk/conditions/spleen-problems-and-spleen-removal/

  Some people are born without a spleen or need to have it removed because of illness or injury. […] A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding. Go straight to AE if you think you have ruptured or damaged your spleen. […] You may need an operation to remove your spleen, known as a splenectomy, if it’s not working properly or it’s damaged, diseased or enlarged. […] Most operations to remove spleens are carried out using keyhole surgery (laparoscopy). […] Open surgery is where one large cut is made. It may be needed if your spleen cannot be removed using keyhole surgery. […] Recovery usually takes a few weeks. Your doctor or nurse will advise when you can go back to your usual activities, such as driving. […] It’s recommended that you take low-dose antibiotics for at least 2 years, and in many cases, the rest of your life, to prevent bacterial infections. […] Healthcare professionals will mark your health records to show that you do not have a working spleen.

• #51 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. […] When presenting with a possible spleen injury, your sports medicine physician will first check your vital signs (blood pressure and heart rate in particular). If you are deemed stable, a good history will be obtained to include how the injury occurred. […] If vital signs are concerning for a low blood pressure and/or a fast heart rate, you will be promptly transferred to the closest Emergency Department (ED) for evaluation and stabilization, as these are signs of a splenic rupture. […] Over 90% of children and 50-70% of adults can be treated non-operatively with temporary rest and restricted activity. […] Surgery or angiographic embolization may be required to stabilize the patient depending on injury severity. […] After a spleen injury, athletes may participate in light activity for 3 months prior to gradually increasing activity intensity. […] Return to play is a collaborative decision that is individualized to the patient.

• #52 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  Treatment is dependent on the severity and etiology of rupture, as well as the hemodynamic stability of the patient. […] Non-operative treatment is attempted in 60% to 90% of patients with blunt traumatic splenic injuries out of a desire to preserve splenic function. […] A landmark 1968 case-control study on operative vs. non-operative management by Upadhyaya and Simpson suggested that isolated splenic injuries could be safely treated without surgery in children. […] Since that case, multiple studies have demonstrated similar outcomes, and non-operative management is the main management option, particularly in the pediatric population. […] Current success rates of 90% are reported in pediatric populations. […] Interventional radiology may be available at some institutions as a means to perform arterial embolization for large or small vessel injuries with bleeding in stable trauma patients.

• #53 Splenic rupture: Information & spleen rupture specialists

  https://www.leading-medicine-guide.com/en/illness/injuries/spleen-rupture

  A ruptured spleen – also known as a ruptured spleen – is an injury to the spleen. It is usually caused by blunt abdominal trauma. This can result in severe internal bleeding. Depending on the extent of the injury, there are five different degrees of severity for a ruptured spleen. If possible, non-surgical, spleen-preserving therapy is preferred today. However, emergency surgery is usually required in the case of a severe spleen rupture. […] The treatment of a ruptured spleen is aimed at repairing and preserving the spleen. Removal of the spleen would result in serious complications. […] In the past, almost every spleen injury was operated on. Today, a non-surgical (conservative) approach is preferred for blunt spleen injuries. The prerequisite for this is that the patient’s circulation is stable or can be stabilized.

• #54 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

  For these reasons, standardized guidelines in the management of splenic trauma are necessary. […] The WSES position paper suggested to group splenic injury into minor, moderate, and severe. This classification has not previously been clearly defined by the literature. Frequently low-grade AAST lesions (i.e., grades IIII) are considered as minor or moderate and treated with NOM. However, hemodynamically stable patients with high-grade lesions could be successfully treated non-operatively, especially exploiting the more advanced tools for bleeding management. […] 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.

• #55 Splenic rupture: Information & spleen rupture specialists

  https://www.leading-medicine-guide.com/en/illness/injuries/spleen-rupture

  The conservative approach includes the wait-and-see strategy, in which the patient is monitored, and interventional therapy with angioembolization. […] However, if a patient cannot be stabilized by blood transfusions, surgery is required. […] Splenorrhaphy is a spleen-preserving operation. The surgeon places constricting sutures and embeds the spleen in an absorbable mesh. […] However, if the bleeding cannot be controlled by this or local hemostasis procedures, the spleen must be partially (partial splenectomy) or completely (splenectomy) removed. […] Current medical recommendations suggest the following basic procedure: In the circulatory stable patient with spleen injury without concomitant injuries: Non-surgical treatment. In patients with stable circulation and spleen injury in whom the bleeding does not stop on its own: angioembolization instead of surgery. In the case of a grade 1, 2 or 3 splenic rupture, if surgery is required: Spleen-preserving surgery. In the case of a type 4 or 5 splenic rupture: splenectomy instead of spleen preservation.

• #56 Splenic Rupture – MD Searchlight

  https://mdsearchlight.com/gut-health/splenic-rupture/

  The treatment approach for a ruptured spleen depends on how severe the rupture is, what caused the rupture, and how stable the patients vital signs (like heart rate and blood pressure) are. […] In an attempt to maintain the spleens vital role in the body, 60% to 90% of patients with ruptured spleens caused by blunt trauma (like a car accident or a fall) are treated without surgery. […] In some hospitals, interventional radiology (a type of medical imaging) can be used to stop bleeding from damaged vessels in stable patients with a ruptured spleen. […] However, surgery may be necessary if a patient remains unstable and/or needs more than four units of blood over two days. The surgeon will initially try to repair any damage to the spleen (a procedure known as splenorrhaphy). If the injury is too severe or if there is uncontrolled bleeding, the spleen may need to be removed (a procedure known as a splenectomy). After spleen removal, vaccines are given to protect against certain bacteria which include Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides. For children who have their spleen removed, its typically recommended to take antibiotics until theyre five years old to protect against infection, although the recommended length of this treatment can vary.

• #57 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  The main complications of conservative treatment or embolisation are ongoing bleeding, splenic necrosis, splenic abscess or cyst formation, and thrombocytosis (typically transient). […] All patients with suspect splenic injury should be assessed, resuscitated, and treated according to ATLS principles. Patients who are haemodynamically unstable or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy. […] Splenic artery embolisation by interventional radiology is an important alternative management option, where available, potentially negating the need for laparotomy and preserving splenic function. […] Consideration should be given for prophylactic vaccinations (against Strep Pneumoniae, Haemophilus Influenzae B (HIB) and Meningococcus) and prophylactic antibiotics (against encapsulated bacteria). […] The overall mortality rates of patients presenting to hospital with trauma splenic injury are around 10%.

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

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

  Non-traumatic or spontaneous ruptures of the spleen are rare but 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. […] Splenic rupture is often overlooked in the differential diagnosis of abdominal pain in the absence of trauma, and in most cases requires splenectomy for treatment. […] Management of SSR primarily depends on the patients hemodynamic stability. The decision to perform a splenectomy, as opposed to spleen-preserving procedures, is guided by the hemodynamic condition of the patient. […] Surgical intervention is warranted in cases of ongoing hemorrhage or hemodynamic instability. High-grade (IVV) injuries generally require splenectomy.

• #59 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  Treatment is dependent on the severity and etiology of rupture, as well as the hemodynamic stability of the patient. […] Non-operative treatment is attempted in 60% to 90% of patients with blunt traumatic splenic injuries out of a desire to preserve splenic function. […] A landmark 1968 case-control study on operative vs. non-operative management by Upadhyaya and Simpson suggested that isolated splenic injuries could be safely treated without surgery in children. […] Since that case, multiple studies have demonstrated similar outcomes, and non-operative management is the main management option, particularly in the pediatric population. […] Current success rates of 90% are reported in pediatric populations. […] Interventional radiology may be available at some institutions as a means to perform arterial embolization for large or small vessel injuries with bleeding in stable trauma patients.

• #60 Splenic Rupture Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

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

  A retrospective analysis by Wu et al compared the use of radiofrequency ablation (RFA) plus suture repair for splenic preservation with traditional splenic preservation surgery in 129 patients with traumatic splenic rupture. […] The postoperative course is usually 5-14 days, depending on associated injuries. […] Patients should also be evaluated for immunizations against Pneumococcus species as a routine of postoperative management. […] The risk of complications or failure of nonoperative management appears to be worse in patients older than 55 years, and women older than 55 years are significantly more likely to fail nonoperative management with an increased mortality. […] Improvements in diagnostic technology, such as helical CT scanners and portable ultrasound, will go far to diagnose and stratify risk in patients with splenic injury.

• #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

  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. […] NOM failure rate is reported to be between 4 and 15%. […] NOM is recommended as first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma. […] NOM should be attempted even in the setting of concomitant head trauma; unless the patient is unstable, and this might be due to intra-abdominal bleeding. […] The presence of contrast blush at CT scan is not an absolute indication for splenectomy or AG/AE in children. […] Patients should undergo to OM in case of hemodynamic instability, failure of conservative treatments, severe coexisting injuries necessitating intervention and peritonitis, bowel evisceration, impalement. […] Splenic preservation (at least partial) should be attempted whenever possible.

• #62 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 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. […] NOM failure rate is reported to be between 4 and 15%. […] NOM is recommended as first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma. […] NOM should be attempted even in the setting of concomitant head trauma; unless the patient is unstable, and this might be due to intra-abdominal bleeding. […] The presence of contrast blush at CT scan is not an absolute indication for splenectomy or AG/AE in children. […] Patients should undergo to OM in case of hemodynamic instability, failure of conservative treatments, severe coexisting injuries necessitating intervention and peritonitis, bowel evisceration, impalement. […] Splenic preservation (at least partial) should be attempted whenever possible.

• #63

• #64 Embolization for Splenic Trauma – Endovascular Today

  https://evtoday.com/articles/2016-apr/embolization-for-splenic-trauma

  Healing the spleen with curative and preventive embolization. […] Until recently, the preferred management of spleen traumas was surgery, but nonoperative management (NOM) is increasingly preferred. NOM increases spleen salvage and thus improves patients immunity to infection (vs those with a compromised immune system due to splenectomy); however, there is a risk of immediate or late bleeding leading to secondary splenectomy. The success rate of NOM may be increased by introducing endovascular treatment into the management strategy, including curative embolization of ongoing bleeding and preventive embolization of high-grade trauma without obvious bleeding lesions. […] The embolization indication is called curative when parenchymal bleeding has to be fixed. […] The indication is called preventive when the goal is to avoid secondary bleeding by decreasing blood pressure into the spleen. […] Embolization has become an important treatment option for the management of splenic trauma, but it needs well-trained radiologists and close follow-up to improve patient outcome.

• #65 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  The main complications of conservative treatment or embolisation are ongoing bleeding, splenic necrosis, splenic abscess or cyst formation, and thrombocytosis (typically transient). […] All patients with suspect splenic injury should be assessed, resuscitated, and treated according to ATLS principles. Patients who are haemodynamically unstable or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy. […] Splenic artery embolisation by interventional radiology is an important alternative management option, where available, potentially negating the need for laparotomy and preserving splenic function. […] Consideration should be given for prophylactic vaccinations (against Strep Pneumoniae, Haemophilus Influenzae B (HIB) and Meningococcus) and prophylactic antibiotics (against encapsulated bacteria). […] The overall mortality rates of patients presenting to hospital with trauma splenic injury are around 10%.

• #66 Ruptured spleen – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ruptured-spleen/diagnosis-treatment/drc-20352322

  Removing part of the spleen. It might be possible to remove only part of your spleen, depending on the rupture. Partial splenectomy reduces the risk of infection that results from removing the entire spleen. […] Spleen surgery is generally safe, but any surgery has risks, such as bleeding, blood clots, infection and pneumonia.

• #67 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 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. […] NOM failure rate is reported to be between 4 and 15%. […] NOM is recommended as first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma. […] NOM should be attempted even in the setting of concomitant head trauma; unless the patient is unstable, and this might be due to intra-abdominal bleeding. […] The presence of contrast blush at CT scan is not an absolute indication for splenectomy or AG/AE in children. […] Patients should undergo to OM in case of hemodynamic instability, failure of conservative treatments, severe coexisting injuries necessitating intervention and peritonitis, bowel evisceration, impalement. […] Splenic preservation (at least partial) should be attempted whenever possible.

• #68 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  The main complications of conservative treatment or embolisation are ongoing bleeding, splenic necrosis, splenic abscess or cyst formation, and thrombocytosis (typically transient). […] All patients with suspect splenic injury should be assessed, resuscitated, and treated according to ATLS principles. Patients who are haemodynamically unstable or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy. […] Splenic artery embolisation by interventional radiology is an important alternative management option, where available, potentially negating the need for laparotomy and preserving splenic function. […] Consideration should be given for prophylactic vaccinations (against Strep Pneumoniae, Haemophilus Influenzae B (HIB) and Meningococcus) and prophylactic antibiotics (against encapsulated bacteria). […] The overall mortality rates of patients presenting to hospital with trauma splenic injury are around 10%.

• #69 JMIR Research Protocols – Quality of Life and Clinical Outcome After Traumatic Spleen Injury (SPLENIQ Study): Protocol for an Observational Retrospective and Prospective Cohort Study

  https://www.researchprotocols.org/2019/5/e12391/

  Surgery is indicated when a patient is hemodynamically unstable and does not respond to transfusion or when associated intraabdominal injuries require surgical management. Possible disadvantages of surgery are postsplenectomy complications, such as sepsis, thrombocytosis, and a lifetime risk of invasive infections (overwhelming postsplenectomy infection). […] Cost-effectiveness is important in the choice of treatment. Published study results on hemodynamically stable patients with splenic injury favored nonsurgical management over surgery with better clinical and cost results. […] To achieve this, the entire process surrounding a patient with splenic injury must be considered. Even today, it remains unclear what the impact of QOL is on the entire process. Therefore, the primary objective of this project is to examine the QOL of patients after therapy (NOM, SAE, and surgery) for traumatic spleen injury using a retrospective and prospective group of patients.

• #70 Blunt splenic trauma – Wikipedia

  https://en.wikipedia.org/wiki/Blunt_splenic_trauma

  Treatment has traditionally been splenectomy. Splenectomy involves ligation of three splenic attachments (splenorenal ligament, splenocolic ligament and splenophrenic ligament) to mobilize the spleen. The splenorenal ligament is located laterally, the splenocolic ligament inferiorly and the splenophrenic ligament superiorly. followed by suture ligation of the splenic blood supply. After the spleen has been removed, the abdomen is irrigated with normal saline to confirm hemostasis. After confirmation abdominal organs are put into anatomical position, followed by closure of the abdomen. […] However, splenectomy is avoided if possible, particularly in children, to avoid the resulting permanent susceptibility to bacterial infections. Most small, and some moderate-sized lacerations in stable patients (particularly children) are managed with hospital observation and sometimes transfusion rather than surgery. Embolization, blocking off of the hemorrhaging vessels, is a newer and less invasive treatment. […] When surgery is needed, the spleen can be surgically repaired in a few cases, but splenectomy is still the primary surgical treatment, and has the highest success rate of all treatments.

• #71 Ruptured spleen – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ruptured-spleen/diagnosis-treatment/drc-20352322

  Removing part of the spleen. It might be possible to remove only part of your spleen, depending on the rupture. Partial splenectomy reduces the risk of infection that results from removing the entire spleen. […] Spleen surgery is generally safe, but any surgery has risks, such as bleeding, blood clots, infection and pneumonia.

• #72 Spleen Injury – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/abdominal-injuries/spleen-injury

  Because of the spleens position in the upper left side of the abdomen, a severe blow to the stomach area can damage the spleen, tearing its covering, the tissue inside, or both. […] Blood transfusions are often needed to treat a spleen injury, and sometimes surgery to remove or repair the spleen is done. […] Doctors used to always remove a damaged spleen. However, removing the spleen can cause later problems, including an increased susceptibility to dangerous infections. Doctors now realize that most small and moderate-sized injuries to the spleen can heal without surgery, although blood transfusions are sometimes required and people must be treated in the hospital. When surgery is necessary, usually the entire spleen is removed (splenectomy), but sometimes surgeons are able to repair a small tear. […] After a splenectomy, certain precautions are needed to prevent infections.

• #73 Embolization for Splenic Trauma – Endovascular Today

  https://evtoday.com/articles/2016-apr/embolization-for-splenic-trauma

  Healing the spleen with curative and preventive embolization. […] Until recently, the preferred management of spleen traumas was surgery, but nonoperative management (NOM) is increasingly preferred. NOM increases spleen salvage and thus improves patients immunity to infection (vs those with a compromised immune system due to splenectomy); however, there is a risk of immediate or late bleeding leading to secondary splenectomy. The success rate of NOM may be increased by introducing endovascular treatment into the management strategy, including curative embolization of ongoing bleeding and preventive embolization of high-grade trauma without obvious bleeding lesions. […] The embolization indication is called curative when parenchymal bleeding has to be fixed. […] The indication is called preventive when the goal is to avoid secondary bleeding by decreasing blood pressure into the spleen. […] Embolization has become an important treatment option for the management of splenic trauma, but it needs well-trained radiologists and close follow-up to improve patient outcome.

• #74 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  Treatment is dependent on the severity and etiology of rupture, as well as the hemodynamic stability of the patient. […] Non-operative treatment is attempted in 60% to 90% of patients with blunt traumatic splenic injuries out of a desire to preserve splenic function. […] A landmark 1968 case-control study on operative vs. non-operative management by Upadhyaya and Simpson suggested that isolated splenic injuries could be safely treated without surgery in children. […] Since that case, multiple studies have demonstrated similar outcomes, and non-operative management is the main management option, particularly in the pediatric population. […] Current success rates of 90% are reported in pediatric populations. […] Interventional radiology may be available at some institutions as a means to perform arterial embolization for large or small vessel injuries with bleeding in stable trauma patients.

• #75 Spleen Injury | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/splenic-trauma/

  How are spleen injuries treated? Treatment for splenic trauma varies depending on the severity of the injury and whether there is continued bleeding from the spleen. Most splenic injuries can be treated with close observation and no operation. These patients stay in the hospital for at least a few days, until its safe to go home. […] In severe cases where the spleen continues to bleed, our experts may recommend surgical treatment that involves removing the spleen, but this is rarely needed. Occasionally, bleeding from the spleen can be treated with an embolization, which is a procedure to block blood vessels to prevent bleeding. […] Childrens Colorado is the only Level 1 Trauma Center in the Rocky Mountain region. Our splenic injury treatment is based on the most up-to-date science and provided by an expert team specialized in treating children.

• #76 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 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. […] NOM failure rate is reported to be between 4 and 15%. […] NOM is recommended as first-line treatment for hemodynamically stable pediatric patients with blunt splenic trauma. […] NOM should be attempted even in the setting of concomitant head trauma; unless the patient is unstable, and this might be due to intra-abdominal bleeding. […] The presence of contrast blush at CT scan is not an absolute indication for splenectomy or AG/AE in children. […] Patients should undergo to OM in case of hemodynamic instability, failure of conservative treatments, severe coexisting injuries necessitating intervention and peritonitis, bowel evisceration, impalement. […] Splenic preservation (at least partial) should be attempted whenever possible.

• #77 Splenic Rupture | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29383

  The initial choice in surgical management is to repair any capsular lacerations (splenorrhaphy). […] If extensive injury or uncontrolled hemorrhage is present, splenectomy is warranted. […] Post-splenectomy vaccinations are intended to address encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides.). […] Children who have a splenectomy are generally recommended to take phenoxymethylpenicillin (Pen VK) until they are 5 years old, though the recommended duration of this prophylaxis varies.

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

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

  Non-traumatic or spontaneous ruptures of the spleen are rare but 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. […] Splenic rupture is often overlooked in the differential diagnosis of abdominal pain in the absence of trauma, and in most cases requires splenectomy for treatment. […] Management of SSR primarily depends on the patients hemodynamic stability. The decision to perform a splenectomy, as opposed to spleen-preserving procedures, is guided by the hemodynamic condition of the patient. […] Surgical intervention is warranted in cases of ongoing hemorrhage or hemodynamic instability. High-grade (IVV) injuries generally require splenectomy.

• #79 Sudden spleen rupture in a Plasmodium vivax-infected patient undergoing malaria treatment | Malaria Journal | Full Text

  https://malariajournal.biomedcentral.com/articles/10.1186/s12936-018-2228-2

  Splenic rupture has a traumatic origin in most cases. […] However, in malaria-endemic countries, infection outnumbers haematological malignancies. Splenic rupture is more prevalent among infections caused by Plasmodium vivax than other species, although precise data on its incidence is presently unknown. […] In terms of treatment, non-operative management can be used in carefully selected cases. Transcatheter splenic artery embolization can be performed in selective cases of non-traumatic rupture. But, in the case of a life threatening situation with uncontrolled bleeding and haemorrhagic shock, splenectomy is still the treatment of choice. […] In conclusion, splenic rupture during acute malaria is rare but is likely underdiagnosed and underreported. It is a life-threatening malaria complication that can occur after starting treatment. Therefore, early diagnosis and appropriate disease management are essential.

• #80 Splenic Rupture During Pregnancy: A Misdiagnosed, Rare Obstetrical Emergency – International Journal of Recent Surgical and Medical Sciences

  https://ijrsms.com/splenic-rupture-during-pregnancy-a-misdiagnosed-rare-obstetrical-emergency/

  Splenic rupture in pregnancy is a rare entity, and the exact ethology is not very clear. Splenic rupture during pregnancy can be due to trauma or spontaneous due to other non-traumatic causes like hemophilias, leukaemia, kalazaar, splenic artery aneurysm, etc. […] Two patients were managed conservatively and had uneventful postoperative period, while splenectomy was done in one case, and feto-maternal mortality was seen in the same. […] The purpose of this case series, comprising three cases, is to identify and enhance awareness of this unusual condition. […] Some cases need splenectomy, while few cases get managed conservatively. […] The most common symptom of atraumatic splenic rupture is left upper quadrant abdominal pain, which is sharp. […] Treatment of splenic rupture involves primary surgical treatment like total splenectomy, non-surgical treatment like splenic arterial embolization, or conservative management.

• #81 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 or spontaneous ruptures of the spleen are rare but 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. […] Splenic rupture is often overlooked in the differential diagnosis of abdominal pain in the absence of trauma, and in most cases requires splenectomy for treatment. […] Management of SSR primarily depends on the patients hemodynamic stability. The decision to perform a splenectomy, as opposed to spleen-preserving procedures, is guided by the hemodynamic condition of the patient. […] In the case of splenectomy, post-operative care is important. Patients need close monitoring with transfusion. If necessary, vaccination should be given 14 days after the surgery. It may cover pneumococcus, haemophilus influenza and meningococcus. […] 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. Ultrasound and CT scans help to orient the diagnosis, and treatment is essentially surgical by splenectomy.

• #82 Splenic injuries – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/splenic-injuries/

  Management resembles approach for traumatic splenic injuries and requires surgical consultation. Most are treated operatively with splenectomy. Nonoperative management with adjunctive angioembolization can be considered in select cases. […] Nonoperative management is appropriate for most stable patients. […] Angioembolization may be considered in patients who respond to fluid resuscitation if there is concern for ongoing bleeding. […] Surgical management: Splenectomy for severe or ongoing bleeding, or if nonoperative management fails. Most patients with atraumatic splenic rupture require splenectomy.

• #83 A Case of Spontaneous Splenic Rupture in Newborn | RGUHS Journal of Medical Sciences | Journalgrid

  https://journalgrid.com/view/article/rjms/12433470

  However, more recently attempts have been made to conserve the spleen. The surgical options include achieving hemostasis by either suturing or using absorbable mesh. […] In a study done in 2002, it was shown that splenectomy is no longer the standard treatment because it increases the chances of post-splenectomy sepsis. Instead, treatment should aim for hemostasis and preservation of spleen. […] If bleeding is small, it may be managed conservatively with fluid resuscitation and continuous monitoring. In our case, as the bleeding did not recur, and the child’s condition remained stable for the next week, conservative management was preferred. Such conservative management has been reported before. The case reported is of splenic rupture that occurred without any known cause in a neonate and showed favourable outcome following conservative management.

• #84 Splenic Rupture During Pregnancy: A Misdiagnosed, Rare Obstetrical Emergency – International Journal of Recent Surgical and Medical Sciences

  https://ijrsms.com/splenic-rupture-during-pregnancy-a-misdiagnosed-rare-obstetrical-emergency/

  Splenic rupture in pregnancy is a rare entity, and the exact ethology is not very clear. Splenic rupture during pregnancy can be due to trauma or spontaneous due to other non-traumatic causes like hemophilias, leukaemia, kalazaar, splenic artery aneurysm, etc. […] Two patients were managed conservatively and had uneventful postoperative period, while splenectomy was done in one case, and feto-maternal mortality was seen in the same. […] The purpose of this case series, comprising three cases, is to identify and enhance awareness of this unusual condition. […] Some cases need splenectomy, while few cases get managed conservatively. […] The most common symptom of atraumatic splenic rupture is left upper quadrant abdominal pain, which is sharp. […] Treatment of splenic rupture involves primary surgical treatment like total splenectomy, non-surgical treatment like splenic arterial embolization, or conservative management.

• #85 Splenic Rupture During Pregnancy: A Misdiagnosed, Rare Obstetrical Emergency – International Journal of Recent Surgical and Medical Sciences

  https://ijrsms.com/splenic-rupture-during-pregnancy-a-misdiagnosed-rare-obstetrical-emergency/

  However, spontaneous splenic hematoma without any underlying cause is rarely reported during pregnancy, but we have observed this in our case 1 mentioned, leading to the wrong diagnosis of abruptio placentae and uterine rupture. […] Conservative management should be followed by intensive monitoring with the facility of round-the-clock availability of intervention radiologists, surgeons, and blood products. […] Emergent laparotomy and splenectomy before the setting of collapse is the essential key to reducing maternal morbidity and mortality and increasing the chances of fetal survival.

• #86 Splenic Rupture Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

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

  A retrospective analysis by Wu et al compared the use of radiofrequency ablation (RFA) plus suture repair for splenic preservation with traditional splenic preservation surgery in 129 patients with traumatic splenic rupture. […] The postoperative course is usually 5-14 days, depending on associated injuries. […] Patients should also be evaluated for immunizations against Pneumococcus species as a routine of postoperative management. […] The risk of complications or failure of nonoperative management appears to be worse in patients older than 55 years, and women older than 55 years are significantly more likely to fail nonoperative management with an increased mortality. […] Improvements in diagnostic technology, such as helical CT scanners and portable ultrasound, will go far to diagnose and stratify risk in patients with splenic injury.

• #87 Splenic Rupture Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details

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

  A retrospective analysis by Wu et al compared the use of radiofrequency ablation (RFA) plus suture repair for splenic preservation with traditional splenic preservation surgery in 129 patients with traumatic splenic rupture. […] The postoperative course is usually 5-14 days, depending on associated injuries. […] Patients should also be evaluated for immunizations against Pneumococcus species as a routine of postoperative management. […] The risk of complications or failure of nonoperative management appears to be worse in patients older than 55 years, and women older than 55 years are significantly more likely to fail nonoperative management with an increased mortality. […] Improvements in diagnostic technology, such as helical CT scanners and portable ultrasound, will go far to diagnose and stratify risk in patients with splenic injury.

• #88 Emergency laparoscopic partial splenectomy for ruptured spleen: A case report

  https://www.wjgnet.com/1007-9327/full/v20/i46/17670.htm

  Emergency laparoscopic partial splenectomy for ruptured spleen: A case report. Splenic rupture is a common consequence of blunt abdominal trauma, which requiring emergency splenectomy when conservative management is not effective. Emergency splenectomy is indicated when conservative management is not effective. A laparoscopic partial splenectomy was required considering the active bleeding and the location of rupture. Laparoscopic partial splenectomy for hemodynamically stable patient with splenic rupture is feasible. However, it is just suitable for selected patients and requires adequate experience with elective laparoscopic partial splenectomy. […] It is a common consensus that laparoscopic surgery has several advantages over open surgery, such as better cosmetics, less blood loss, and faster recovery.

• #89 JMIR Research Protocols – Quality of Life and Clinical Outcome After Traumatic Spleen Injury (SPLENIQ Study): Protocol for an Observational Retrospective and Prospective Cohort Study

  https://www.researchprotocols.org/2019/5/e12391/

  The secondary objective is to investigate the clinical outcome (eg, complications, reinterventions, and additional therapy), imaging outcome (diagnosis and magnetic resonance spleen imaging after SAE), and cost outcome (cost-effectiveness) and their relation to QOL. […] In conclusion, the SPLENIQ study responds to the shortage of information about QOL after treatment for traumatic spleen injury. With developing a patient-oriented protocol, a necessary step is taken to customize standard care, which may contribute to a positive effect on QOL and clinical outcome.

• #90 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

  For these reasons, standardized guidelines in the management of splenic trauma are necessary. […] The WSES position paper suggested to group splenic injury into minor, moderate, and severe. This classification has not previously been clearly defined by the literature. Frequently low-grade AAST lesions (i.e., grades IIII) are considered as minor or moderate and treated with NOM. However, hemodynamically stable patients with high-grade lesions could be successfully treated non-operatively, especially exploiting the more advanced tools for bleeding management. […] 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.

• #91 Splenic Trauma – StatPearls – NCBI Bookshelf

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

  The collaboration between surgery and interventional radiology has allowed patients to undergo spleen salvage who once would have been managed by laparotomy and splenectomy. As is noted above, spleen salvage has increasingly been the goal of management in splenic trauma, with a focus on promoting infectious disease outcomes and avoidance of the potential complications of the laparotomy procedure itself, which can occur even if laparotomy is done when indicated and under the best of preoperative circumstances, which is not necessarily always the case during emergency splenectomies.

• #92 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 optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. […] The management of splenic trauma has changed considerably in the last few decades especially in favor of non-operative management (NOM). NOM ranges from observation and monitoring alone to angiography/angioembolization (AG/AE) with the aim to preserve the spleen and its function, especially in children.

• #93 Splenic Rupture – StatPearls – NCBI Bookshelf

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

  Treatment is dependent on the severity and etiology of rupture, as well as the hemodynamic stability of the patient. […] Non-operative treatment is attempted in 60% to 90% of patients with blunt traumatic splenic injuries out of a desire to preserve splenic function. […] A landmark 1968 case-control study on operative vs. non-operative management by Upadhyaya and Simpson suggested that isolated splenic injuries could be safely treated without surgery in children. […] Since that case, multiple studies have demonstrated similar outcomes, and non-operative management is the main management option, particularly in the pediatric population. […] Current success rates of 90% are reported in pediatric populations. […] Interventional radiology may be available at some institutions as a means to perform arterial embolization for large or small vessel injuries with bleeding in stable trauma patients.

• #94 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 optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. […] The management of splenic trauma has changed considerably in the last few decades especially in favor of non-operative management (NOM). NOM ranges from observation and monitoring alone to angiography/angioembolization (AG/AE) with the aim to preserve the spleen and its function, especially in children.

• #95 Splenic rupture: Information & spleen rupture specialists

  https://www.leading-medicine-guide.com/en/illness/injuries/spleen-rupture

  The conservative approach includes the wait-and-see strategy, in which the patient is monitored, and interventional therapy with angioembolization. […] However, if a patient cannot be stabilized by blood transfusions, surgery is required. […] Splenorrhaphy is a spleen-preserving operation. The surgeon places constricting sutures and embeds the spleen in an absorbable mesh. […] However, if the bleeding cannot be controlled by this or local hemostasis procedures, the spleen must be partially (partial splenectomy) or completely (splenectomy) removed. […] Current medical recommendations suggest the following basic procedure: In the circulatory stable patient with spleen injury without concomitant injuries: Non-surgical treatment. In patients with stable circulation and spleen injury in whom the bleeding does not stop on its own: angioembolization instead of surgery. In the case of a grade 1, 2 or 3 splenic rupture, if surgery is required: Spleen-preserving surgery. In the case of a type 4 or 5 splenic rupture: splenectomy instead of spleen preservation.

• #96 Splenic rupture: Information & spleen rupture specialists

  https://www.leading-medicine-guide.com/en/illness/injuries/spleen-rupture

  The conservative approach includes the wait-and-see strategy, in which the patient is monitored, and interventional therapy with angioembolization. […] However, if a patient cannot be stabilized by blood transfusions, surgery is required. […] Splenorrhaphy is a spleen-preserving operation. The surgeon places constricting sutures and embeds the spleen in an absorbable mesh. […] However, if the bleeding cannot be controlled by this or local hemostasis procedures, the spleen must be partially (partial splenectomy) or completely (splenectomy) removed. […] Current medical recommendations suggest the following basic procedure: In the circulatory stable patient with spleen injury without concomitant injuries: Non-surgical treatment. In patients with stable circulation and spleen injury in whom the bleeding does not stop on its own: angioembolization instead of surgery. In the case of a grade 1, 2 or 3 splenic rupture, if surgery is required: Spleen-preserving surgery. In the case of a type 4 or 5 splenic rupture: splenectomy instead of spleen preservation.

• #97 Ruptured spleen – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ruptured-spleen/diagnosis-treatment/drc-20352322

  Treatment for a ruptured spleen will depend on the seriousness of your condition. Severe injuries usually require immediate surgery. […] Many small or moderate-sized injuries to the spleen can heal without surgery. You’re likely to stay in the hospital while your health care team observe your condition and provide nonsurgical care, such as blood transfusions, if necessary. […] You might have periodic follow-up CT scans to check whether your spleen has healed or to determine whether you need surgery. […] Surgery for a ruptured spleen can include: […] Repairing the spleen. Your surgeon might be able to use stitches or other techniques to repair the rupture. […] Removing the spleen, called a splenectomy. People can live without a spleen, but it increases the risk of serious bacterial infections such as sepsis. Your health care provider may recommend vaccinations against meningitis, pneumonia and haemophilus influenza, type b (Hib). Occasionally, you may be prescribed daily oral antibiotics to prevent infections.

• #98 Spleen problems and spleen removal | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/spleen-problems-and-spleen-removal/

  The spleen can become damaged or may rupture (burst) after a forceful blow to the abdomen, car accident, sporting accident or fracture to the ribs. […] A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding. […] An operation to remove the spleen, known as a splenectomy, may be needed if the spleen is damaged, diseased or enlarged. […] Most splenectomies are carried out using laparoscopy (keyhole surgery). […] Open surgery, where one large incision is made, may be needed if the spleen is too large or too damaged to be removed via keyhole surgery. […] Its normal to feel sore and be bruised after a splenectomy, but youll be given pain relief medication. […] Recovery usually takes a few weeks. Your doctor or nurse will advise when you can go back to your usual activities, such as driving. […] If your spleen needs to be removed, other organs such as the liver can take over many of the spleens functions. […] Its recommended that you take low-dose antibiotics for the rest of your life to prevent bacterial infections.

• #99 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. While surgery is not always necessary, timely treatment is critical. […] Treatment for a ruptured spleen typically falls into two camps: several days of intensive hospital care or surgery. […] If the injury or damage to the spleen is too great, or if doctors are unable to stop the internal bleeding, a splenectomy is often the treatment of choice. In 10% to 15% of patients with a blunt spleen injury, surgical spleen removal is necessary. […] However, in some cases, a more conservative approach is taken. Several days of hospital care and regular testing will be necessary to make sure the injury to the spleen doesn’t worsen. […] With proper treatment and follow-up care, recovery from a ruptured spleen is typically excellent. Some people may be able to recover from a ruptured spleen with hospital care and recovery time. Others may require surgery to remove the damaged spleen. […] If you’ve been injured and have symptoms of a ruptured spleen, seek emergency care right away.

• #100 Ruptured spleen (ruptured spleen) – USZ

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

  A ruptured spleen is an emergency in which doctors must act quickly! This is because life-threatening bleeding can occur in the abdomen, which must be stopped quickly. […] There are various treatment options for a ruptured spleen. Which doctors choose depends on the extent and severity of the injury as well as the amount and type of concomitant injuries. Sometimes a ruptured spleen can be treated conservatively without surgery. In other cases, surgery is necessary. However, doctors always try to preserve the spleen, because the spleen fulfills important immunological functions (defense against infection)! Sometimes this is not successful and the spleen has to be partially or completely removed. […] 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. If only the spleen is injured, factors such as age and the amount of blood loss also play a role in the prognosis. […] There are various treatment options for a ruptured spleen. Which therapy is used depends on the severity of the disease. Specialists can often treat a minor injury to the spleen conservatively without surgery. In more severe cases, however, surgical intervention is necessary.

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