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Abdoh Q, Samara E, Zayed A, Khader M, Maqboul I, Rashed MAM. Dieulafoy lesion with rare vascular complications: diagnostic and therapeutic approach. J Surg Case Rep 2024; 2024:rjae750. [PMID: 39664273 PMCID: PMC11630252 DOI: 10.1093/jscr/rjae750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 11/13/2024] [Indexed: 12/13/2024] Open
Abstract
Dieulafoy lesions are a rare cause of gastrointestinal bleeding, characterized by an enlarged submucosal blood vessel that bleeds without visible abnormalities. The diagnosis is typically made via endoscopy, and treatment usually involves endoscopic therapy. This case involves a 46-year-old female who presented with upper gastrointestinal bleeding due to a Dieulafoy's lesion, treated with band ligation and later embolization after the lesion was found to originate from the left phrenic artery. The patient developed rare complications, including splenic infarction and pleural effusion, which required additional management. Upon initial investigations, the patients had an accidental finding on computed tomography of asymptomatic celiac artery compression that was advised to take into consideration for the possibility of developing median arcuate ligament syndrome and was treated conservatively. The case highlights the diagnostic and therapeutic challenges of Dieulafoy's lesion and underscores the need for individualized treatment and further research.
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Affiliation(s)
- Qusay Abdoh
- Department of Internal Medicine, GI and Endoscopy Unit, An-Najah National University Hospital, Asira Street, Nablus, Palestine
| | - Enas Samara
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Al-Junaid Street, Nablus, Palestine
| | - Alaa Zayed
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Al-Junaid Street, Nablus, Palestine
| | - Mohammed Khader
- Department of Interventional Radiology, An-Najah National University Hospital, Asira Street, Nablus, Palestine
| | - Iyad Maqboul
- Department of General Surgery and Radiology, An-Najah National Hospital, Asira Street, Nablus, Palestine
| | - Mohammed A M Rashed
- Department of Radiology, Rafedia Hospital, Rafidia Main Street, Nablus, Palestine
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Comparison of outcomes of proximal versus distal and combined splenic artery embolization in the management of blunt splenic injury: a report of 202 cases from a single trauma center. Surg Endosc 2023:10.1007/s00464-023-09960-5. [PMID: 36890415 DOI: 10.1007/s00464-023-09960-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND To compare the outcomes of blunt splenic injuries (BSI) managed with proximal (P) versus distal (D) versus combined (C) splenic artery embolization (SAE). METHODS This retrospective study included patients with BSI who demonstrated vascular injuries on angiograms and were managed with SAE between 2001 and 2015. The success rate and major complications (Clavien-Dindo classification ≥ III) were compared between the P, D, and C embolizations. RESULTS In total, 202 patients were enrolled (P, n = 64, 31.7%; D, n = 84, 41.6%; C, n = 54, 26.7%). The median injury severity score was 25. The median times from injury to SAE were 8.3, 7.0, and 6.6 h for the P, D, and C embolization, respectively. The overall haemostasis success rates were 92.6%, 93.8%, 88.1%, and 98.1% in the P, D, and C embolizations, respectively, with no significant difference (p = 0.079). Additionally, the outcomes were not significantly different between the different types of vascular injuries on angiograms or the materials used in the location of embolization. Splenic abscess occurred in six patients (P, n = 0; D, n = 5; C, n = 1), although it occurred more commonly in those who underwent D embolization with no significant difference (p = 0.092). CONCLUSIONS The success rate and major complications of SAE were not significantly different regardless of the location of embolization. The different types of vascular injuries on angiograms and agents used in different embolization locations also did not affect the outcomes.
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Cretcher M, Panick CEP, Boscanin A, Farsad K. Splenic trauma: endovascular treatment approach. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1194. [PMID: 34430635 PMCID: PMC8350634 DOI: 10.21037/atm-20-4381] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
The spleen is a commonly injured organ in blunt abdominal trauma. Splenic preservation, however, is important for immune function and prevention of overwhelming infection from encapsulated organisms. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become an important component of non-operative management (NOM). SAE decreases the blood pressure to the spleen to allow healing, but preserves splenic perfusion via robust collateral pathways. SAE can be performed proximally in the main splenic artery, more distally in specific injured branches, or a combination of both proximal and distal embolization. No definitive evidence from available data supports benefits of one strategy over the other. Particles, coils and vascular plugs are the major embolic agents used. Incorporation of SAE in the management of blunt splenic trauma has significantly improved success rates of NOM and spleen salvage. Failure rates generally increase with higher injury severity grades; however, current management results in overall spleen salvage rates of over 85%. Complication rates are low, and primarily consist of rebleeding, parenchymal infarction or abscess. Splenic immune function is felt to be preserved after embolization with no guidelines for prophylactic vaccination against encapsulated bacteria; however, a complete understanding of post-embolization immune changes remains an area in need of further investigation. This review describes the history of SAE from its inception to its current role and indications in the management of splenic trauma. The endovascular approach, technical details, and outcomes are described with relevant examples. SAE is has become an important part of a multidisciplinary strategy for management of complex trauma patients.
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Affiliation(s)
- Maxwell Cretcher
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Catherine E P Panick
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Alexander Boscanin
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
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Zhang L, Zhang ZG, Long X, Liu FL, Zhang WG. Severe Complications After Splenic Artery Embolization for Portal Hypertension Due to Hepatic Cirrhosis. Risk Manag Healthc Policy 2020; 13:135-140. [PMID: 32110126 PMCID: PMC7037048 DOI: 10.2147/rmhp.s234628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/29/2020] [Indexed: 01/01/2023] Open
Abstract
Background Splenomegaly/hypersplenism is one of the most common complications of portal hypertension. Splenic artery embolization (SAE) has been increasingly used for treatment of splenomegaly/hypersplenism. However, few studies focused on the severe complications after embolization. In this paper, we reported 16 cases of severe complications after SAE for portal hypertension. Methods From February 2011 to January 2019, 16 cirrhotic patients were diagnosed with severe complications after embolization. The clinical symptoms, therapies and prognosis were analyzed. Results In these patients, the splenic embolization volume was between 50% and 70%. Among 16 cases, 7 patients were diagnosed with splenic abscess and/or left subphrenic abscess, suffered from the insistent fever, and eventually underwent the surgical therapy; 6 patients with left refractory pleural effusion, suffered from severe chest distress, and underwent repeated thoracocentesis or thoracic closed drainage; 3 patients with thrombosis in portal vein needed oral warfarin therapy. Conclusion In cirrhotic patients, the severe complications after SAE are not uncommon after the procedure. It causes more suffering, prolonged hospital stay and more medical cost in these patients. It was debatable whether this technique was an appropriate technique for portal hypertension due to liver cirrhosis, patients contraindicated for the treatment should be carefully identified to avoid the complications.
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Affiliation(s)
- Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Zhan-Guo Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Xin Long
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Fei-Long Liu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Wan-Guang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
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Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference. J Trauma Acute Care Surg 2019; 84:517-531. [PMID: 29261593 DOI: 10.1097/ta.0000000000001774] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Non-surgical Management of Blunt Splenic Trauma: A Comparative Analysis of Non-operative Management and Splenic Artery Embolization—Experience from a European Trauma Center. Cardiovasc Intervent Radiol 2018; 41:1324-1332. [DOI: 10.1007/s00270-018-1953-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/30/2018] [Indexed: 12/12/2022]
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Rong JJ, Liu D, Liang M, Wang QH, Sun JY, Zhang QY, Peng CF, Xuan FQ, Zhao LJ, Tian XX, Han YL. The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis. Mil Med Res 2017; 4:17. [PMID: 28573044 PMCID: PMC5450228 DOI: 10.1186/s40779-017-0125-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Splenic artery embolization (SAE) has been an effective adjunct to the Non-operative management (NOM) for blunt splenic injury (BSI). However, the optimal embolization techniques are still inconclusive. To further understand the roles of different embolization locations and embolic materials in SAE, we conducted this system review and meta-analyses. METHODS Clinical studies related to SAE for adult patients were researched in electronic databases, included PubMed, Embase, ScienceDirect and Google Scholar Search (between October 1991 and March 2013), and relevant information was extracted. To eliminate the heterogeneity, a sensitivity analysis was conducted on two reduced study sets. Then, the pooled outcomes were compared and the quality assessments were performed using Newcastle-Ottawa Scale (NOS). The SAE success rate, incidences of life-threatening complications of different embolization techniques were compared by χ2 test in 1st study set. Associations between different embolization techniques and clinical outcomes were evaluated by fixed-effects model in 2nd study set. RESULTS Twenty-three studies were included in 1st study set. And then, 13 of them were excluded, because lack of the necessary details of SAE. The remaining 10 studies comprised 2nd study set, and quality assessments were performed using NOS. In 1st set, the primary success rate is 90.1% and the incidence of life-threatening complications is 20.4%, though the cases which required surgical intervention are very few (6.4%). For different embolization locations, there was no obvious association between primary success rate and embolization location in both 1st and 2nd study sets (P > 0.05). But in 2nd study set, it indicated that proximal embolization reduced severe complications and complications needed surgical management. As for the embolic materials, the success rate between coil and gelfoam is not significant. However, coil is associated with a lower risk of life-threatening complications, as well as less complications requiring surgical management. CONCLUSIONS Different embolization techniques affect the clinical outcomes of SAE. The proximal embolization is the best option due to the less life-threatening complications. For commonly embolic material, coil is superior to gelfoam for fewer severe complications and less further surgery management.
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Affiliation(s)
- Jing-Jing Rong
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Dan Liu
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Ming Liang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Qing-Hua Wang
- Department of Cardiology, Xinqiao Hospital of Third Military Medical University, Chongqing, 400038 China
| | - Jing-Yang Sun
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Quan-Yu Zhang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Cheng-Fei Peng
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Feng-Qi Xuan
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Li-Jun Zhao
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Xiao-Xiang Tian
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Ya-Ling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
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Cormack RJ, Ferris MC, Wong JK, Przybojewski S. Splenic artery embolisation in the non-operative management of blunt splenic trauma in adults. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The purpose of this study was to evaluate the splenic salvage rate with angioembolisation in the non-operative management (NOM) of blunt splenic injury.Methods: We conducted a retrospective analysis of patients presenting to our Level I trauma centre with computed tomography (CT)-confirmed splenic injury following blunt trauma and in whom angioembolisation was utilised in the algorithm of NOM. Data review included CT and angiography findings, embolisation technique and patient outcomes.Results: Between January 2005 and April 2010, 60 patients with splenic injury following blunt trauma underwent NOM, which included splenic artery embolisation (SAE). All patients included in the study required a preadmission. CT scan was used to document the American Association for the Surgery of Trauma (AAST) grade of splenic injury. The average injury grade was 3.0. The non-operative splenic salvage rate following SAE was 96.7% with statistically similar salvage rates achieved for grades II to IV injuries. The quantity of haemoperitoneum and the presence of a splenic vascular injury did not significantly affect the splenic salvage rate. The overall complication rate was 27%, of which 15% were minor and 13% were major.Conclusion: SAE is a safe and effective treatment strategy in the NOM of blunt splenic injury. The quantity of haemoperitoneum, the presence of vascular injury and embolisation technique did not significantly affect the splenic salvage rate.
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Abstract
Better understanding of the dual functionality of the spleen has led to a conservative approach to splenic trauma. With accurate assessment and vigilant clinical examination up to two thirds of splenic injuries can be managed expectantly; when surgery is unavoidable, splenic preserving techniques may be used to maintain function.
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Affiliation(s)
- Jml Williamson
- Specialty Registrar in the Department of Surgery, Bristol Royal Infirmary, Bristol BS2 8HW
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Zheng CH, Xu M, Huang CM, Li P, Xie JW, Wang JB, Lin JX, Lu J, Chen QY, Cao LL, Lin M. Anatomy and influence of the splenic artery in laparoscopic spleen-preserving splenic lymphadenectomy. World J Gastroenterol 2015; 21:8389-8397. [PMID: 26217091 PMCID: PMC4507109 DOI: 10.3748/wjg.v21.i27.8389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/31/2015] [Accepted: 04/17/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the splenic hilar vascular anatomy and the influence of splenic artery (SpA) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy (LTGSPL). METHODS The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups (concentrated group vs distributed group) according to the distance between the splenic artery's furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups. RESULTS There were 205 patients with a concentrated type (64.7%) and 112 patients with a distributed type (35.3%) SpA. There were 22 patients (6.9%) with a single branch of the splenic lobar vessels, 250 (78.9%) with 2 branches, 43 (13.6%) with 3 branches, and 2 patients (0.6%) with multiple branches. Eighty seven patients (27.4%) had type I splenic artery trunk, 211 (66.6%) had type II, 13 (4.1%) had type III, and 6 (1.9%) had type IV. The mean splenic hilar lymphadenectomy time (23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy (14.78 ± 11.09 vs 17.37 ± 10.62 mL; P = 0.044), and number of vascular clamps used at the splenic hilum (9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups (P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups (P > 0.05). CONCLUSION It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type SpA may be optimal patients for training new surgeons.
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Cook MR, Holcomb JB, Rahbar MH, Fox EE, Alarcon LH, Bulger EM, Brasel KJ, Schreiber MA. An abdominal computed tomography may be safe in selected hypotensive trauma patients with positive Focused Assessment with Sonography in Trauma examination. Am J Surg 2015; 209:834-40. [PMID: 25805456 DOI: 10.1016/j.amjsurg.2015.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/08/2015] [Accepted: 01/17/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Positive Focused Assessment with Sonography in Trauma examination and hypotension often indicate urgent surgery. An abdomen/pelvis computed tomography (apCT) may allow less invasive management but the delay may be associated with adverse outcomes. METHODS Patients in the Prospective Observational Multicenter Major Trauma Transfusion study with hypotension and a positive Focused Assessment with Sonography in Trauma (HF+) examination who underwent a CT (apCT+) were compared with those who did not. RESULTS Of the 92 HF+ identified, 32 (35%) underwent apCT during initial evaluation and apCT was associated with decreased odds of an emergency operation (odds ratio .11, 95% confidence interval .001 to .116) and increased odds of angiographic intervention (odds ratio 14.3, 95% confidence interval 1.5 to 135). There was no significant difference in 30-day mortality or need for dialysis. CONCLUSIONS An apCT in HF+ patients is associated with reduced odds of emergency surgery, but not mortality. Select HF+ patients can safely undergo apCT to obtain clinically useful information.
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Affiliation(s)
- Mackenzie R Cook
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L611, Portland, OR 97239, USA.
| | - John B Holcomb
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mohammad H Rahbar
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Erin E Fox
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Louis H Alarcon
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Karen J Brasel
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L611, Portland, OR 97239, USA
| | - Martin A Schreiber
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L611, Portland, OR 97239, USA
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Kokabi N, Shuaib W, Xing M, Harmouche E, Wilson K, Johnson JO, Khosa F. Intra-abdominal Solid Organ Injuries: An Enhanced Management Algorithm. Can Assoc Radiol J 2014; 65:301-9. [DOI: 10.1016/j.carj.2013.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 12/20/2013] [Indexed: 12/26/2022] Open
Abstract
The organ injury scale grading system proposed by the American Association for the Surgery of Trauma provides guidelines for operative versus nonoperative management in solid organ injuries; however, major shortcomings of the American Association for the Surgery of Trauma injury scale may become apparent with low-grade injuries, in which conservative management may fail. Nonoperative management of common intra-abdominal solid organ injuries relies increasingly on computed tomographic findings and other clinical factors, including patient age, presence of concurrent injuries, and serial clinical assessments. Familiarity with characteristic imaging features is essential for the prompt diagnosis and appropriate treatment of blunt abdominal trauma. In this pictorial essay, the spectrum of the American Association for the Surgery of Trauma organ injury scale grading system is illustrated, and a multidisciplinary management algorithm for common intra-abdominal solid organ injuries is proposed.
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Affiliation(s)
- Nima Kokabi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Minzhi Xing
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elie Harmouche
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth Wilson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Jamlik-Omari Johnson
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal Khosa
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Yao T, Rong J, Liang M, Sun J, Xuan F, Zhao L, Wang X, Li F, Wang G, Han Y. Emergency treatment of splenic injury in a novel mobile minimally invasive interventional shelter following disaster: a feasibility study. Scand J Trauma Resusc Emerg Med 2014; 22:44. [PMID: 25103472 PMCID: PMC4129467 DOI: 10.1186/s13049-014-0044-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/23/2014] [Indexed: 11/18/2022] Open
Abstract
Background There has been an increase in natural disasters in recent years, which leads to a great number of injuries and deaths. It still remains an unsolved problem to treat patients with vascular injury of solid organs effectively following natural disasters, but on-spot emergency interventional transcatheter arterial embolization (TAE) has been highly recommended to cure serious vascular injury of solid organs nowadays. Spleen is the most vulnerable abdominal organ, severe arterial hemorrhage of which can cause death if untreated timely. In this research, we aimed to study the possibility of performing emergency surgical intervention in mobile minimally invasive interventional shelter for splenic injury in the case of natural disasters. Methods First, the mobile minimally invasive interventional shelter was unfolded in the field, and then disinfection and preoperative preparation were performed immediately. Eight large animal models of splenic injury were created, and angiograms were performed using a digital subtraction angiography machine in the mobile minimally invasive interventional shelter, and then the hemostatic embolizations of injured splenic artery were performed following the established convention of rapid intervention therapy. The operating time was recorded, and the survival condition and postoperative complications were observed for two weeks. Results and discussion The average time of unfolding the shelter, and performing disinfection and preoperative preparation was 33 ± 7 min. The number of colonies in the sterilized shelter body was 86 ± 13 cfu/m3. The average TAE time was 31 ± 7 min. All the hemostatic embolizations of splenic injury were performed successfully in the mobile minimally invasive interventional shelter during the operation. A pseudoaneurysm was found in an animal model using angiography two weeks after the operation. The primary clinical success rate of embolization was 87.5%. The two-week survival rate in all animal models of splenic injury was 100%. Conclusions Our findings in the current study demonstrate that the mobile minimally invasive interventional shelter can be adapted to the field perfectly and complete emergency surgical intervention for splenic injury efficiently and safely. Therefore, on-spot emergency interventional TAE for vascular injury of solid organs (e.g. spleen) in mobile minimally invasive interventional shelter is available and effective.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yaling Han
- Department of Cardiology, The general hospital of Shenyang Military Region, Shenyang 110016, China.
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Gu JJ, He XH, Li WT, Ji J, Peng WJ, Li GD, Wang SP, Xu LC. Safety and efficacy of splenic artery coil embolization for hypersplenism in liver cirrhosis. Acta Radiol 2012; 53:862-7. [PMID: 22855417 DOI: 10.1258/ar.2012.110639] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Partial splenic artery embolization is an effective treatment for hypersplenism but often lacks long-term benefits. PURPOSE To evaluate the long-term effects of coil embolization of the splenic artery in patients with liver cirrhosis and hypersplenism. MATERIAL AND METHODS Forty-nine patients with liver cirrhosis and hypersplenism underwent coil embolization of the main splenic artery. The coils were deployed in the mid- or distal segment of the splenic artery to allow collateral blood flow to the spleen. The following data were collected from 2 weeks to 4 years after the embolization: technical success, length of hospital stay, white blood cell count, platelet count, splenic volume, and complication. RESULTS The technical success rate of splenic artery coil embolization was 100%. The post embolization syndrome rate was 75% (36/49) with no incidence of major complications. The mean length of hospital stay was 9 days. After embolization, the patient's white blood and platelet counts increased significantly, peaked at 2 weeks, and gradually decreased during the 4-year follow-up period, but remained at significantly higher levels than pre-embolization levels. Follow-up CT scans demonstrated a gradual increase in the volume of the enhanced portions of the spleens with a decrease in the volume of unenhanced portion. No significant changes occurred in the red blood cell count and liver function after the embolization. CONCLUSION Embolization of the mid-and distal main splenic artery with coils is a safe and effective treatment of hypersplenism in cirrhosis with long-term hematologic benefits.
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Affiliation(s)
- Jian-Jian Gu
- Department of Oncology, People's Hospital of Tongzhou District, Nantong City, Jiangsu Province
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xin-Hong He
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wen-Tao Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jun Ji
- Department of Oncology, People's Hospital of Tongzhou District, Nantong City, Jiangsu Province
| | - Wei-Jun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Guo-Dong Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Sheng-Ping Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li-Chao Xu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
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