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01-11-2003 | Review Article

Conservative management of splenic trauma: history and current trends

Author: P. Upadhyaya

Published in: Pediatric Surgery International | Issue 9-10/2003

Abstract

Evolution of the present-day policy of conservative management of ruptured spleen has been hailed as one of the most notable advances in pediatric surgery. Until 1971, routine splenectomy used to be the sacrosanct treatment for splenic trauma. It was universally believed that non-operative management carried a high mortality of 90 to 100%. Sporadic reports of successful conservative treatment appeared in the early twentieth century, but regrettably, these were ignored. Likewise, experimental studies pointing to the danger of post-splenectomy sepsis were also disregarded. Dominant surgical opinion continued to practice removal of the injured spleen. In 1968, Upadhyaya and Simpson, based on a well-designed clinical analysis of 52 children made a convincing plea for conservative management. In 1971, Upadhyaya et al. presented results of a corroborative experimental study, which provided the conclusive evidence that isolated splenic tears are well tolerated and heal spontaneously by first intention. Seeing the surge of publications that followed this presentation, it becomes apparent that this study constituted the real turning point that changed the world opinion in favour of salvage of the ruptured spleen. By 1979, numerous authors had reported the safety of non-operative management in hundreds of children all over the world. Currently, the policy of routine splenectomy has been universally abandoned; and the reported salvage rate of ruptured spleen is more than 90%. This paper traces the historical perspectives in the management of injured spleen from the times of Aristotle to the present day.

Ambrosino DM (1992) Response to Haemophilus influenzae type B conjugate vaccine in children undergoing splenectomy. J Pediatr Surg 27:1045PubMed

Angerpointner TA, Lauterjung KL, Hoffecer A (1990) Hemostasis in injuries of parenchymatous organs by infrared contact coagulation. Prog Pediatr Surg 25:32–38PubMed

Aristotle: Parts of Animals, Book III. (1955) English translation by A.L.Peck. Harvard Univ. Press, Cambridge, Chap. 12

Aronson DZ, Sherz AW, Einborn AH et al (1977) Nonoperative management of splenic trauma in children. A report of six consecutive cases in children. Pediatrics, 60:482–485

Baesl TJ, Filler RM (1985) Surgical diseases of the spleen. In: Sheldon CA, Martin LW (eds) Symposium on pediatric surgery, part 1. Surg Clin North Amer Philadelphia 65 (5):1269–1286

Bailey H (1927) Traumatic rupture of normal spleen. Br J Surg 15:40–46

Barnes AF (1914) Subcutaneous traumatic rupture of normal spleen. Ann Surg 59:597–609

Beardmore H (1984) Cited in Upadhyaya P (1986) Rationale of conservative management of splenic trauma in children. Indian J Surg 48:175–177

Benjamin CI, Engrav LH, Perry JF Jr (1976) Delayed rupture or delayed diagnosis of rupture of the spleen. Surg Gynecol Obstet 142(2):171–172PubMed

10.

Berger F (1902) Die Verletzungen der milz und ihre chirurgische behandlung. Arch Klin Chir 68:56

11.

Berlatzky Y, Shiloni E, Anner H, Weiss Y (1980) “Delayed rupture of the spleen” or delayed diagnosis of the splenic injury? Isr J Med Sci 16(9–10):659–664

12.

Billroth T (1881) Clinical Surgery, London. New Sydenham Society: 229

13.

Black IJ, Sinow RM, Wilson SE, Williams RA (1992) Subcapsular hematoma as a predictor of delayed splenic rupture. Am Surg 58(12): 732–735PubMed

14.

Bond SJ et al (1996) Nonoperative management of blunt hepatic and splenic injury in children. Ann Surg 233:286CrossRef

15.

Buntain WL, Lynn HB (1979) Splenorrhaphy: changing concepts for the traumatized spleen. Surgery 86:748PubMed

16.

Burrington JD (1977) Surgical repair of a ruptured spleen in children. Arch Surg 112:417–419PubMed

17.

Chapman J (1836) Case of excised spleen [case #21]. Trans Med Phys Soc, Calcutta. 8: Pt 1, Appendix 30

18.

Coil JA, Dickerman JD, Bolton E (1978) Increased susceptibility of splenectomized mice to infection after exposure to an aerosolized suspension of Type III streptococcus pneumoniae. Infect Immun 21:412–416PubMed

19.

Coghill TH, Moore EE, Jurkovich GJ et al (1989) Nonoperative management of blunt splenic trauma: a muticenter experience. J Trauma 29 (10):1312–1317PubMed

20.

Conti S (1980) Splenic artery ligation for trauma. An alternative for splenectomy. Am J Surg 140(3):444–446PubMed

21.

Cristo MC (1962) Segmental resection of the spleen: report on first eight cases operated on. Hospital (RIO) 62 (3):575–590

22.

Cruger DD (1684) De exiciso liene ex homine,sine noxa. (observatio 195). Misc Curiosa Acad Caes Leopol Caro Nat Curiosa S2, 3:378–380

23.

Douglas GJ, Simpson JS (1971) The conservative management of splenic trauma. J Pediatr Surg 6:565–570PubMed

24.

Dretzka L (1930) Rupture of the spleen. Report of 27 cases. Surg Gynecol Obstet 51:258–261

25.

Ein SH, Shandling B, Simpson JS et al (1977) The morbidity and mortality of splenectomy in childhood. Ann Surg 185:307–310PubMed

26.

Ein SH, Shandling B, Simpson JS et al (1978) Nonoperative management of traumatized spleen in children. How and why. J Pediatr Surg 13:117–119PubMed

27.

Fasoli L, Bettili G, Bianchi S et al (1998) Spleen rupture in the newborn: Conservative surgical treatment using absorbable mesh. J Trauma 45(3):642–643PubMed

28.

Gavant ML, Schurr M, Flick PA et al (1997) Predicting clinical outcome of non-surgical management of blunt splenic injury using CT to reveal abnormalities of splenic vasculature. AJR Am J Roentgenol 168 (1):207–212PubMed

29.

Gellis S (1975) Year Book of Pediatrics,. Year Book Medical Publishers, Chicago, p 303

30.

Gibbon JH (1908) Rupture of the spleen (a reported discussion). Ann Surg 48:152

31.

Gunther CEM (1939) Spontaneous healing of a ruptured spleen, discovered at autopsy. Med J Australia 1:655–656

32.

Hendren WH, Kim SH (1975) Trauma of the spleen and liver in children. Pediatr Clin N Amer 22(2): 349–364

33.

Hoellwarth ME, Breisach G (1978) Zur konservativen therapie der posttraumatischen milruptur. Chirug 49:711–713

34.

Hoellwarth ME, Breisach G (1980) Beitrag zur konservativen behandlung von itzverletzungen. Monatschr kinderheilkunde 98:712–14

35.

Huebner S, Reed MH (2001) Analysis of the value of imaging as part of the follow-up of splenic injury in children. Pediatr Radiol 31(12):852–855CrossRefPubMed

36.

Hunter EA (1935) Ruptured spleen with delayed haemorrhage and spontaneous cure. Br Med J 2:256

37.

Joseph TP, Wyllie GG, Savage JP (1977) The nonoperative management of splenic trauma. Austral N Z J Surg 47:179–182

38.

Jurkovitch GJ, Cogbill TH, Moore EE et al (1989) Nonoperative management of blunt splenic trauma: A multicenter experience. J Trauma 29:1312–1317PubMed

39.

Keramidas D, Buyukunal C, Seyus D, Dolatzas T (1991) Splenic artery ligation: a ten year experience in the treatment of selected cases of splenic injuries in children. Jpn J Surg 21:172–177PubMed

40.

King H, Shumacker HB Jr (1952) Splenic studies. 1. Susceptibility to infection after splenectomy performed in infancy. Ann Surg 136:239–242

41.

Knudson MM, Maull KL (1999) Nonoperative management of solid organ injuries:Past, present and future. Surg Clin North Am 79(6):1357–1371PubMed

42.

Kocher ET (1911) In: Stiles HJ, Paul CB (eds) Textbook of operative surgery, 3rd edn.Black, London, pp 565–566

43.

Kochler R H, Smith RS, Fry WR (1994) Successful laparoscopic splenorrhaphy using absorbable mesh for grade III splenic injury: report of a case. Surg Laprose Endosc 4(4):311–315

44.

Konradsen HB, Henrichsen J (1991) Pneumococcal infections in splenectomized children are preventable. Acta Pediatr Scand 80:423

45.

Konradsen HB, Pedersen FK, Henrichsen J (1990) Pneumococcal revaccination of splenectomized children. Pediatr Infec Dis J 9:258

46.

Kram HR, del-Junco D, Clark SR et al (1990) Technique of splenic preservation using fibrin glue. J Trauma 30 (1):97–101PubMed

47.

Krumbhaar EB (1915) The history of extirpation of the spleen. New York Med J 101:232–234

48.

Lally KP, Rosario V, Mahour GH, Wolley MM (1990) Evolution in the management of splenic injury in children. Surg Gynecol Obstet 170:245–248PubMed

49.

Ludtke FE, Schuff-Werner P, Lion KA, Spear CP (1990) Immunorestorative effect of reimplanted splenic tissue and splenosis. J Surg Res 49:413–418PubMed

50.

Mazel MS (1945) Traumatic rupture of the spleen with special reference to its characteristics in young children. J Pediatr 16:82–88

51.

McIndoe AH (1932) Delayed haemorrhage following traumatic rupture of the spleen. Br J Surg 20:249–268

52.

Meade RH (1968) Surgery of spleen. In: An Introduction to the History of General Surgery. Saunders, Philadelphia London Toronto, pp 256–260

53.

Michalski S, Blankenhorn P, Lepsien G, Ludtke FE (1991) Fatal infection after splenectomy despite reimplantation of splenic tissue. Klin-Wochenschr 69:375–378

54.

Michel L A, Lacrose M, Decanniere L et al (1997) Spiral computed tomography for three dimensional reconstruction for severe blunt abdominal traumas: a useful complementary tool. Eur J Emerg Med 4 (2):87–93PubMed

55.

Mishalany H (1974) Repair of the ruptured spleen. J Pediatr Surg 9:175–178PubMed

56.

Mishalany H, Mahour GH, Andrassy RJ et al (1978) Modalities of preservation of the traumatized spleen. Am J Surg 136:697–700PubMed

57.

Morgenstern L (1974) The surgical inviolability of the spleen. Historical evolution of a concept. In: Proceedings of 23^rd International Congress of the History of Medicine 1972, London, pp 62–68

58.

Morris DH, Bullock FD (1919) The importance of the spleen in resistance to infection. Ann Surg 70:513–521

59.

Morse MA,Garcia VF (1994) Selective non-operative management of pediatric blunt splenic trauma: risk of missed associated injuries. J Pediat Surg 29(1):23–27PubMed

60.

Moskvicev VG (1990) Ein verfahren zur blunstillung bei stumpfem milztrauma (A method of haemostasis in blunt splenic trauma) Radiol Diagn Berlin 31(5):505–512

61.

Okinaga K, Giebink GS, Hampton-Rich R et al (1981) The effect of partial splenectomy on experimental pneumococcal bacteraemia in an experimental model. J Pediatr Surg 16:717–723PubMed

62.

Olsen WR, Polley TZ Jr (1977) A second look at delayed splenic rupture. Arch Surg 112:422–425PubMed

63.

Oschner MG, Maniscalco-Theberge ME, Champion HR (1990) Fibrin glue as a haemostatic agent in hepatic and splenic trauma. J Trauma 30 (7):884–887PubMed

64.

Pearl RH, Wesson DE, Spence LJ et al (1989) Splenic injury: A 5–year update with improved results and changing criteria for conservative management. J Pediatr Surg 24:121–125PubMed

65.

Pickhardt B, Moore FF, McCroskey RI et al (1989) Operative splenic salvage in adults: a decade perspective. J Trauma 29(10):1386–1391PubMed

66.

Pneumococcal polysaccharide vaccine. Recommendations of the immunization advisory committee (1982) Ann Intern Med 96:203–205

67.

Pugh L (1946) Splenectomy with special reference to its historical background. Collective reviews. Int Abstr Surg 83:209–244

68.

Ratner MH, Garrow E, Valda V et al (1977) Surgical repair of the injured spleen. J Pediatr Surg 12:1019–1025PubMed

69.

Santulli TV (1981) Presidential address: Pediatric surgery has grown up. J Pediatr Surg 16:779–789PubMed

70.

Scheele J, Gentsch HH, Matterson E (1984) Splenic repair by fibrin tissue adhesive and collagen fleece. Surgery 95:6-13PubMed

71.

Senn N (1903) The surgical treatment of traumatic hemorrhage of the spleen. JAMA 41:1241–1245

72.

Shackford SR, Sise WJ, Veergilio RW, Peters RM (1981) Evaluation of splenorrhaphy: a grading system for splenic trauma. J Trauma 21:538–542PubMed

73.

Shafir R, Dinbar A, Webstein I et al (1975) Nonoperative treatment of splenic injury. Report of a case. J Trauma 15:935–936PubMed

74.

Sherman NJ, Morris JA (1978) Conservative surgery for splenic injuries. Pediatrics 61:267–271PubMed

75.

Sherman R (1980) Perspectives in management of trauma to the spleen: 1979 Presidential address, American Association for the Surgery of Trauma. J Trauma 20:1-13PubMed

76.

Shirkey AL, Wukasch DC, Beall AC Jr et al (1964) Surgical management of splenic injuries. Am J Surg 108:630PubMed

77.

Singer DB (1973) Postsplenectomy sepsis. Perspect Pediat Pathol 1:285–311

78.

Siniluoto TM, Paivansalo MG, Lanning FP et al (1992) Ultrasonography in traumatic splenic rupture. Clin Radiol 46(6):391–396PubMed

79.

Sjovall A, Hirsch K (1997) Blunt abdominal trauma in children. J Pediatr Surg 32 (8)1169–1174

80.

Smith RS, Meister RK, Tsoi FK et al (1993) Laparoscopically guided blood salvage and autotransfusion in splenic trauma. J Trauma 34(21):313–314PubMed

81.

Solheim K (1979) Nonoperative management of splenic trauma. Acta Chir Scand 145:55–58PubMed

82.

Strauch GO (1979) Preservation of splenic function in adults and children with injured spleen. Am J Surg 137:478–483PubMed

83.

Sugrue M, Knox A, Sarre R et al (1991) Management of splenic trauma: A new CT-guided splenic injury grading system. Aust N Z J Surg 61(5):349–353PubMed

84.

Thal ER, McClelland RN, Shires GT (1979) Abdominal trauma. In: Shires GT (ed) Care of the trauma patient. 2nd edn. McGraw-Hill, New York, p 337

85.

Turnbull HM (1927) Cited In: Bailey H (ed) Traumatic rupture of the normal spleen. Br J Surg 15:43

86.

Umlas SL, Cronan JJ (1991) Splenic trauma: can CT grading system enable prediction of successful nonsurgical treatment. Radiology 178 (2):481–487PubMed

87.

Upadhyaya P, Simpson JS (1968) Splenic trauma in children. Surg Gynecol Obstet 126:781–790PubMed

88.

Upadhyaya P, Nayak NC, Moitra S (1971) Experimental study of splenic trauma in monkeys. J Pediatr Surg 6:767–773PubMed

89.

Upadhyaya P (1986) Rationale of conservative management of splenic trauma in children. Indian J Surg 48:175–177

90.

Upadhyaya P (1971) Splenic trauma in children. A corroborative experimental study. La Voce del “Gaslini” Genova. 5 (suppl.5): 14

91.

Variet F, Tardieu D, Cottalorda J et al (1998) Treatment of blunt splenic trauma in children (in French). Ann Chir 52:1017–1021PubMed

92.

Weinstein ME, Govin GG, Rice CL et al (1979) Splenorrhaphy for splenic trauma. J Trauma 19:692–697PubMed

93.

Welch KJ (1979) Surgery of Spleen. In: Ravitch et al (eds) Pediatric Surgery 3rd edn. Year Book Medical Publishers. Chicago London, p 133

94.

Wesson DE, Filler RM, Ein SH et al (1981) Ruptured spleen – When to operate? J Pediatr Surg 16:324–326PubMed

95.

Whitaker AN (1968) The effect of previous splenectomy on the course of pneumococcal bacteremia in mice. J Pathol Bacteriol 95:357–376PubMed

96.

Witte CI, Esser MJ, Rappaport WD (1992) Updating the management of salvageable splenic injury. Ann Surg 215(3):261–5PubMed

97.

Zabinski EJ, Harkins HN (1943) Delayed splenic rupture. A clinical syndrome following trauma: Report of four cases with analysis of 177 cases collected from the literature. Arch Surg 46:186–213

Title: Conservative management of splenic trauma: history and current trends
Author: P. Upadhyaya
Publication date: 01-11-2003
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 9-10/2003
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-003-0972-y

Keynote webinar | Spotlight on medication adherence

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Conservative management of splenic trauma: history and current trends

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Keynote webinar | Spotlight on medication adherence

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