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Open Access

An update on nonoperative management of the spleen in adults

Ben L Zarzaur, Grace S Rozycki
DOI: 10.1136/tsaco-2017-000075 Published 9 June 2017
Ben L Zarzaur
1 Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Grace S Rozycki
2 Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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    Figure 1

    Pseudoaneurysm (arrow) noted on initial CT scan.

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    Figure 2

    Selective angioembolization of bleeding splenic vessel (arrow).

  • Figure 3
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    Figure 3

    Specimen shows embolized portion of spleen as dark area (arrow). Bleeding occurred from splenic hilum.

  • Figure 4
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    Figure 4

    Transverse image of spleen with pseudoaneurysms in the upper pole. Contrast is poorly timed as neither the aorta nor pseudoaneurysm appear bright.

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    Figure 5

    Repeat CT scan showing splenic hematoma and extraparenchymal pseudoaneurysm (arrow).

Tables

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  • Table 1

    Adaptation of AAST Organ Injury Scale for Spleen

    Grade Injury typeDescription of injury
    IHematoma
    Laceration
    Subcapsular, <10% surface area
    Capsular tear, <1 cm parenchymal depth
    IIHematomaSubcapsular, 10% to 50% surface area
    Intraparenchymal, <5 cm in diameter
    LacerationCapsular tear, 1 cm to 3 cm parenchymal depth that does not involve a trabecular vessel
    IIIHematoma
    Laceration 
    Subcapsular, >50% surface are or expanding: ruptured subcapsular or parenchymal hematoma: intraparenchymal hematoma_>5 cm or expanding
    3 cm parenchymal depth or involving trabecular vessels
    IVLacerationLaceration involving segmental or hilar vessels producing major devascularization (>25% of spleen)
    VLaceration
    Vascular
    Completely shattered spleen
    Hilar vascular injury with devascularizes spleen 
    • Adapted from American Association for the Surgery of Trauma organ injury scale for spleen.

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An update on nonoperative management of the spleen in adults
Ben L Zarzaur, Grace S Rozycki
Trauma Surg Acute Care Open Jun 2017, 2 (1) e000075; DOI: 10.1136/tsaco-2017-000075

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An update on nonoperative management of the spleen in adults
Ben L Zarzaur, Grace S Rozycki
Trauma Surg Acute Care Open Jun 2017, 2 (1) e000075; DOI: 10.1136/tsaco-2017-000075
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An update on nonoperative management of the spleen in adults
Ben L Zarzaur, Grace S Rozycki
Trauma Surgery & Acute Care Open Jun 2017, 2 (1) e000075; DOI: 10.1136/tsaco-2017-000075
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  • Article
    • Abstract
    • Background
    • Spleen anatomy and its relationship to splenic salvage
    • Immune function of the spleen
    • The evolution of nonoperative management of the spleen
    • Splenic injury grades and nonoperative management
    • Risk factors for the failure of nonoperative management
    • Angioembolization: pros and cons
    • Monitoring the patient
    • Patient follow-up and repeat imaging
    • Conclusions and recommendations
    • Footnotes
    • References
  • Figures & Data
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