Zülfü Bayhan, Sezgin Zeren, Mehmet Ekici, Cüneyt Kahraman, Turgay Şimşek

Comparison of the Clinical Outcome of Nonoperative Management and Surgical Treatment of Blunt Splenic Trauma

Objective: Nonoperative management is the preferred treatment option of blunt splenic injury in appropriate conditions. İncreasing success is achieved with the help of advanced imaging techniques and angioembolization procedure. We aimed to compare clinical outcomes of Nonoperative Management and Surgical Intervention in patients with blunt splenic injury.Methods: Records of 56 patients who were treated by nonoperative management or surgical intervention in our clinic were reviewed retrospectively. Patients were evaluated in terms of age, gender, grade of injury, mortality, length of hospital stay, complications, presence of additional injuries and concomitant disease in both groups.Results: There were 29 patients (51.78%) in the surgery group and 27 patients (48.2%) in the nonoperative management group. Grade of injury was determined significantly higher in surgical treatment group (p<0.001). Additional injury was observed more in the group treated with surgery (p: 0.033). Infectious complication rate was found higher in surgically treated group (<0.001). There was no significant difference between the groups in terms of age, gender, mortality, length of hospital stay, presence of concomitant disease.Conclusion: Nonoperative management is the appropriate method in treatment of blunt splenic injury in patients who were hemodinamically stable and have no signs of peritoneal irritation. Nonoperative management is increasingly being implemented in conjunction with improvements in imaging methods. Angioembolization is a treatment that increases the success rate of nonoperative management and implementation of this method in trauma centers is an important target. Surgical intervention is inevitable in cases when the nonoperative management is inappropriate.Key words: Blunt splenic injury, Nonoperative Management, Splenectomy, Splenoraphy.

Anahtar Kelimeler:

Künt dalak yaralanması, Konservatif tedavi, Splenektomi, Splenorafi

Determining a Safe Time for Oral Intake Following Pediatric Sedation

Objective: While there are suggestions for oral hydration times after general anesthesia, there is no published study with regard to sedation. The aim of this prospective study was to determine a safe time for oral intake after pediatric sedation and its association with nausea and vomiting after discharge.Methods: A total of 180 children (aged 1 month to 13 years) sedated for magnetic resonance imaging were randomly assigned into three groups. All patients fasted for 6 hours and were allowed to take clear fluids until 2 hours before sedation with thiopental (3 mg/kg). After the patients were transported to the recovery room, we allowed the patients to drink as much clear fluids as they wanted prior to discharge in group I, 1 hour after the patients met the discharge criteria for group II, and 2 hours after the patients met the discharge criteria for group III. All patients were assessed for vomiting in the recovery room until 1 hour after their first oral hydration. The parents were then telephoned the next day and questioned regarding nausea/vomiting and any unanticipated hospital admission.Results: There were no statistically significant intergroup differences with respect to age, sex, weight, or the ASA status. There was no nausea and vomiting in either the recovery or post discharge period in any group. In the telephone questionnaire, no hospital admissions were reported.Conclusion: Oral hydration just before discharge is safe, and fasting children after discharge for a period of time is unnecessary for patients sedated with thiopental.Key words: Sedation, oral intake, postoperative nausea and vomiting

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Schroeppel TJ, Croce MA. Diagnosis and management of blunt abdominal solid organ injury. Curr Opin Crit Care 2007;13:399–404.
Millikan JS, Moore EE, Moore GE, Stevens RE. Alternatives to splenectomy in adults after trauma. Repair, partial resection, and reimplantation of splenic tissue. Am J Surg 1982;144:711-716.
Krause KR, Howells GA, Bair HA, et al. Nonoperative management
of blunt splenic injury in adults 55 years and older: a twenty-year experience. Am Surg 2000;66:636-640.
Bain IM, Kirby RM. 10 year experience of splenic injury. An
increasing place for conservative management after blunt trauma. Injury 1998;29:177-182.
Watanabe S, Ishi T, Kamachi M, Takahashi T. Computed tomography and nonoperative treatment for blunt abdominal
trauma. Jpn J Surg 1990;20:56-63.
Olthof DC, Joosse P, van der Vlies CH, et al. Prognostic factors
for failure of nonoperative management in adults with blunt splenic injury: a systematic review. J Trauma Acute Care Surg 2013;74:546-557.
Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995;38:323-324.
Tan KK, Chiu MT, Vijayan A. Management of isolated splenic
injuries after blunt trauma: an institution’s experience over 6 years. Med J Malaysia 2010;65:304-306.
Miller PR, Chang MC, Hoth JJ, et al. Prospective trial of angiography and embolization for all grade III toV blunt splenic injuries: nonoperative management success rate is significantly improved. Am Coll Surg 2014;218:644–648.
Velmahos GC, Zacharias N, Emhoff TA, et al. Management of the most severely injured spleen: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Arch Surg 2010;145:456–460.
Peitzman AB, Heil B, Rivera L, et al. Blunt splenic injury in adults: Multiinstitutional Study of the Eastern Association for the Surgery of Trauma. J Trauma 2000;49:177-187.
Dehli T, Bagenholm A, Trasti NC, et al. The treatment of spleen injuries: a retrospective study. Scand J Trauma Resusc Emerg Med 2015;23:85.
Okuş A, Sevinç B, Ay S, et al. Conservative management of abdominal injuries. Ulus Cerrahi Derg 2013;29:153-157.
Soo KM, Lin TY, Chen CW, et al. More becomes less: management strategy has definitely changed over the past
decade of splenic injury- a nationwide population-based study. Biomed Res Int 2015;2015:124969.
Pachter HL, Guth AA, Hofstetter SR, Spencer FC. Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg 1998;227:708-719.
Feliciano DV, Bitondo CG, Mattox KL, et al. A four-year experience with splenectomy versus splenorrhaphy. Ann Surg 1985;201:568-575.