Management strategy for splenic trauma

: evaluation of angiography and arterial embolization

Abstract

<Method> We classified a total of 150 patients with splenic trauma who had undergone treatment at our institution over the past 29 years into 3 groups according to the management strategy: G-Ⅰ, consisting of 40 cases (1988-1995: principally laparotomized), G-Ⅱ, consisting of 41 cases (1996-2002: aggressive transcatheter arterial embolization (TAE)), and G-Ⅲ, consisting of 69 cases (2003-2016: early laparotomy intended at salvage surgery). The validity of the strategy in each group was judged by the rate of success and the splenic salvage rate. <Results> Conversion of the management strategy was required in 7, 17 and 9% of patients in G-Ⅰ, G-Ⅱ and G-Ⅲ, respectively. In G-Ⅱ, 5 of the 11 patients who had been treated by TAE as the initial management strategy subsequently required total splenectomy. All of these 5 cases showed extrasplenic extravasation of contrast on the initial CT. Moreover, among all the 11 patients, one patient needed continuous epidural anesthesia for pain control, and another patient required readmission for splenic infarction, abscess and pleural effusion. In G-Ⅲ, early laparotomy was adopted for cases who showed hemodynamic instability and extrasplenic extravasation on CT. The splenic salvage rate in G-Ⅰ, G-Ⅱ and G-Ⅲ were 43, 51 and 78%, respectively. <Conclusion> The present strategy performed in G-Ⅲ can lower the strategy conversion rate and yield the highest splenic salvage rate, in my experience.