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Abdominal trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Steven Stylianos, Mark V. Mazziotti
Who could have imagined the influence of James Simpson's publication in 1968 on the successful non-operative treatment of select children presumed to have splenic injury? Initially suggested in the early 1950s by Tim Warnsborough, then Chief of General Surgery at the Hospital for Sick Children in Toronto, it is remarkable to consider that the era of non-operative management for pediatric spleen injury began with the report of 12 children treated between 1956 and 1965. The diagnosis of splenic injury in this select group was made by clinical findings together with routine laboratory and plain X-ray findings. It should be borne in mind that the report predated ultrasound (US), computed tomography (CT), or isotope imaging.
Complications in Laparoscopic Colorectal Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Shobhit Sengar
The operative risk of splenic injury ranges from 0.4% to 8% for colonic procedures [6,7]. Injury occurs because of the close proximity of the colon to the spleen. During mobilization of the splenic flexure of the colon, excessive traction on the peritoneal attachments and omentum can lead to avulsion of a portion of the splenic capsule [8]. The risk of incidental splenic injuries is significantly greater for open compared to laparoscopic colorectal resection [9]. Other factors that increase the risk for iatrogenic splenic injury include previous abdominal surgery, midline incision, obesity, and advanced age. Management of an intraoperative splenic injury includes splenic salvage (primary repair, splenorrhaphy) or splenectomy. Splenic salvage should be the first maneuver to control bleeding and a splenectomy reserved for cases when bleeding cannot be controlled by the previously described techniques. These patients who need an emergent splenectomy would need to be vaccinated for pneumococcal and H. influenza infections at the time of discharge.
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
What are the symptoms and signs of splenic injury?Left upper quadrant pain (capsular stretching)Peritonism (due to extravasated blood)Kehr's sign − left shoulder tip pain due to blood irritating diaphragmAssociated injuries − low left rib fractures, bruising of lateral chest and abdominal wall
Splenic abscess complicating endoscopic retrograde cholangiopancreatography
Published in Baylor University Medical Center Proceedings, 2018
Travis Haneke, Andrew J. Widmer, Austin Metting
This case is unique because only one other case of splenic abscess complicating ERCP has been reported. Nearly all other previously reported complications were related to splenic injury and/or hematoma formation as opposed to an abscess. Because of the high mortality rate, splenic abscesses should be identified quickly. Splenectomy or drainage of the abscess with adjuvant antibiotic therapy should be performed in a timely manner. When undergoing procedures such as ERCP, risks and benefits should be carefully weighed, particularly in cases of chronic pancreatitis. Awareness of this rare complication in such cases is important in quickly diagnosing injury or abscess.
Incidence and characteristics of pancreatic injuries among trauma patients admitted to a Norwegian trauma centre: a population-based cohort study
Published in Scandinavian Journal of Gastroenterology, 2020
Johannes Wiik-Larsen, Kenneth Thorsen, Knut Olav Sandve, Kjetil Søreide
Baseline characteristics of the patients are presented in Table 1. Six patients had an isolated pancreatic injury. In patients with multiple injuries, liver injury was the most frequent organ injured (n = 4). One patient had concomitant splenic injury (Figure 2). None of the 14 patients had kidney injury. Hollow viscus injury was seen in five patients. Injury to the stomach (n = 2) and duodenum (n = 2) was equally frequent. One patient had an injury to the biliary tract. Four patients had associated injuries in other body regions, all with thoracic injury. Three of these had additional injuries to the head, face, and extremities.
Spontaneous splenic rupture associated with Escherichia coli bacteremia and dual antiplatelet therapy
Published in Baylor University Medical Center Proceedings, 2020
Carlos A. Perez, Alexander Bastidas, Saranya Rajasekar, Nawal Nasser, Victor O. Garcia-Rodriguez
Splenic rupture requires immediate surgical intervention in most cases.2 A conservative approach with nonoperative management and/or embolization is considered in low-grade splenic injury and hemodynamically stable patients.12 SSR symptoms are nonspecific and can be confounded by other causes of abdominal pain. If unrecognized, SSR can lead to hemorrhagic shock and death. This case highlights two mechanisms that lead to SSR and also expands the spectrum of infectious agents associated with this condition.