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Review Article
Splenic artery embolization for trauma: a narrative review
Simon Roh
J Trauma Inj. 2024;37(4):252-261.   Published online December 16, 2024
DOI: https://doi.org/10.20408/jti.2024.0056
  • 2,852 View
  • 132 Download
AbstractAbstract PDF
The management of traumatic splenic injuries has evolved significantly over the past several decades, with the majority of these injuries now being treated nonoperatively. Patients who exhibit hemodynamic instability upon initial evaluation typically require surgical intervention, while the remainder are managed conservatively. Conservative treatment for traumatic splenic injuries encompasses both medical management and splenic artery angiography, followed by embolization in cases where patients exhibit clinical signs of ongoing splenic hemorrhage. Splenic artery embolization is generally divided into two categories: proximal and distal embolization. The choice of embolization technique is determined by the severity and location of the splenic injury. Patients who retain functioning splenic tissue after trauma do not routinely need immunization. This is in contrast to post-splenectomy patients, who are at increased risk for opportunistic infections.
Summary
Case Reports
Successful nonoperative management of a simultaneous high-grade splenic injury and devascularized kidney in Australia: a case report
Peter Thanh Tam Nguyen, Jeremy M. Hsu
J Trauma Inj. 2023;36(4):431-434.   Published online September 7, 2023
DOI: https://doi.org/10.20408/jti.2023.0017
  • 1,790 View
  • 34 Download
  • 1 Web of Science
AbstractAbstract PDF
Severe blunt injuries to isolated solid abdominal viscera have been previously managed nonoperatively; however, management algorithms for simultaneous visceral injuries are less well defined. We report a polytrauma case of a 33-year-old man involved in a motorbike collision who presented with left-sided chest and abdominal pain. Initial imaging demonstrated multiple solid organ injuries with American Association for the Surgery of Trauma (AAST) grade V splenic injury and complete devascularization of the left kidney. The patient underwent urgent angioembolic coiling of the distal splenic artery with successful nonoperative management of simultaneous grade V solid organ injuries.
Summary
Very large haematoma following the nonoperative management of a blunt splenic injury in a patient with preexisting liver cirrhosis: a case report
Euisung Jeong, Younggoun Jo, Yunchul Park, Jungchul Kim, Hyunseok Jang, Naa Lee
J Trauma Inj. 2022;35(1):66-70.   Published online December 24, 2021
DOI: https://doi.org/10.20408/jti.2021.0077
  • 3,427 View
  • 86 Download
AbstractAbstract PDF
The spleen is the most commonly injured organ after blunt abdominal trauma. Nonoperative management (NOM) is the standard treatment for blunt splenic injuries in haemodynamically stable patients without peritonitis. Complications of NOM include rebleeding, new pseudoaneurysm formation, splenic abscess, and symptomatic splenic infarction. These complications hinder the NOM of patients with blunt splenic injuries. We report a case in which a large haemorrhagic fluid collection that occurred after angio-embolisation was resolved by percutaneous drainage in a patient with liver cirrhosis who experienced a blunt spleen injury.
Summary
Original Articles
Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management
Joung Won Na, Jung Nam Lee, Byung Chul Yu, Min A Lee, Jae Jung Park, Gil Jae Lee
J Trauma Inj. 2017;30(3):91-97.   Published online October 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.3.91
  • 2,528 View
  • 24 Download
AbstractAbstract PDF
PURPOSE
The prognostic factors of non-operative management (NOM) in high-grade spleen injuries have been extensively studied, but factors that would help treatment decisions are lacking. We compared the characteristics of the patients to identify the factors affecting treatment choices.
METHODS
This is a review of 207 blunt spleen injury patients from January 2004 to December 2013. We compared clinical features and mortality between surgery and NOM, and used multivariate regression analysis to find the factor most strongly associated with prognosis.
RESULTS
Of the 207 patients, 107 had high-grade spleen injury patents (grade III or above). Of these, 42 patients underwent surgery and 65 patients underwent NOM. The mortality was 7% following surgery, 3% with NOM. The amount of packed red blood cells transfused in the first 24 hours and spleen injury grade were associated with management type, and mortality was highly associated with activated partial thromboplastin time (aPTT) and spleen injury grade.
CONCLUSIONS
The grade of spleen injury was associated with management and mortality, so correctly assessing the spleen injury grade is important.
Summary
Analysis of Abdominal Trauma Patients Using National Emergency Department Information System
In Gyu Song, Jin Suk Lee, Sung Won Jung, Jong Min Park, Han Deok Yoon, Jung Tak Rhee, Sun Worl Kim, Borami Lim, So Ra Kim, Il Young Jung
J Trauma Inj. 2016;29(4):116-123.   Published online December 31, 2016
DOI: https://doi.org/10.20408/jti.2016.29.4.116
  • 3,884 View
  • 25 Download
  • 2 Citations
AbstractAbstract PDF
PURPOSE
To develop an inclusive and sustainable trauma system as the assessment of burden of injuries is very much important. The purpose of this study was to evaluate the estimates and characteristics of abdominal traumatic injuries.
METHODS
The data were extracted from the National Emergency Department Information System. Based on Korean Standard Classification for Disease 6th version, which is the Korean version of International Classification of Disease 10th revision, abdominal injuries were identified and abdominal surgeries were evaluated with electronic data interchange codes. Demographic factors, numbers of surgeries and clinical outcomes were also investigated.
RESULTS
From 2011 to 2014, about 24,696 patients with abdominal trauma were admitted to the hospitals annually in South Korea. The number of patients who were admitted to regional and local emergency medical centers was 8,622 (34.91%) and 15,564(63.02%), respectively. Based on National Emergency Department Information System, liver was identified as the most commonly injured abdominal solid organ (39.50%, 9,754/24,696, followed by spleen (17.57%, 4,338/24,696) and kidney (12.94%, 3,195/24,696).
CONCLUSION
This study shows that the demand for abdominal trauma care is considerable in South Korea and most of the patients with abdominal trauma were admitted to regional or local emergency centers. The results of this study can be used as good source of information for staffs to ensure proper delivery of abdominal trauma care in trauma centers nationally.
Summary

Citations

Citations to this article as recorded by  
  • Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review
    Simon Roh
    Journal of Trauma and Injury.2023; 36(3): 165.     CrossRef
  • Abdominal stab wound in A Pregnant woman resulting in Evisceration, Uterine Perforation and Fetal Chest Injury: A Case Report and Literature Review
    Oumarou O, Landry TW, Joe NC, Wirwah FT, Ulrich BS, Jean-Paul EN
    Journal of Surgery and Surgical Research.2019; : 010.     CrossRef
Diversity of the Definition of Stable Vital Sign in Trauma Patients: Results of a Nationwide Survey
Seong Pyo Mun, Young Sun Yoo
J Trauma Inj. 2014;27(4):115-125.
  • 1,486 View
  • 7 Download
AbstractAbstract PDF
PURPOSE
Stable vital signs (SVSs) are thought to be the most important criteria for successful non-operative management (NOM) of blunt spleen injury (BSI). However, a consistent definition of SVSs has been lacking. We wanted to evaluate the diversity of the definitions of SVSs by using a nationwide survey.
METHODS
A questionnaire regarding the definition of SVSs was sent to the trauma surgeons working at the Department of Trauma Surgery and Emergency Medicine at a level-I trauma center between October 2011 and November 2011. Data were compared using analyses of the variance, t-tests, chi2 tests and logistic regressions.
RESULTS
Among 201 surgeons, 198 responded (98.2%). Of these 198 responses, 45 were incomplete, so only 153 (76.1%) were analyzed. In defining the SVSs, significant diversity existed on the subjects of type of blood pressure (BP), cut-off value for hypotension, technique for measuring BP, duration of hypotension, whether or not to use the heart rate (HR) as a determinant, cut-off value of hypotension when the patient had a comorbidity or when the patient was a child. Of the 153 surgeons whose responses were analyzed, 91.5% replied that they were confused when defining SVSs.
CONCLUSION
Confusion exists regarding how to define SVSs. Most surveyed surgeons felt that a need existed to clarify both the definition of SVSs and the use of SVSs to determine hemodynamic stability for NOM.
Summary
CT Based Hemoperitoneum Scoring for Clinicians: Objectifying the Severity of Splenic Injury and Recovery
Hong Kyung Shin, Ra Yeong Song, Ho Seong Han, Yoo Seok Yoon, Jai Young Cho, Dae Wook Hwang, Kyuwhan Jung, Young Ki Kim, Woo Hyung Lee
J Trauma Inj. 2013;26(4):273-278.
  • 1,699 View
  • 12 Download
AbstractAbstract PDF
PURPOSE
In patients with splenic trauma, Computed Tomography (CT) scan is helpful in selecting treatment options and evaluating resolution after NOM (Non-Operative Management). The purpose of this study was to suggest a CT based hemoperitoneum (HP) scoring system that can easily be used by clinicians to evaluate the severity of injury and recovery.
METHODS
A retrospective review of patients with splenic trauma admitted to our hospital between May 2003 and January 2013 was conducted. Patients diagnosed with isolated spleen injury who had a CT scan on admission were included. 1 or 2 points were given according to location and amount of hematoma in the CT image. Using the existing ultrasonography (US) based HP scoring system, the same method was applied to obtain our CT based HP scoring (CBHS) system, which ranges from 0 to 8 points. The CBHS system can be easily used by clinicians for a quick assessment of splenic injury.
RESULTS
Of the 39 patients meeting the inclusion criteria, 6 patients were managed operatively and 33 non-operatively. There was a significant difference in CBHS between the OM (operative management) group and the NOM group.(p=0.03) CBHS showed correlation with Hb (hemoglobin), Hct (hematocrit), spleen injury grade(AAST), and Hounsfield unit of ROI (Region of interest). (p=0.17, p=0.18, p<0.000, p=0.02, respectively) After successful NOM with stabilized Hb level, the amount of hemoperitoneum was scored in the follow-up CT. CBHS demonstrated correlation with decreased spleen injury grade, decreased Hounsfield unit of ROI (Region of interest) (p=0.039, p=0.049, respectively), and also objectively reflected patient recovery.
CONCLUSION
CBHS can be used as an objective and intuitive tool for clinicians in grading the severity of splenic injury by scoring the amount of hemoperitoneum, and in assessing recovery.
Summary
Case Report
Trivial Trauma and Non Pathological Delayed Splenic Rupture: A Case Report
Kwang Min Kim, Kuk Jin Kim, Hyun Chul Kim
J Trauma Inj. 2013;26(1):34-37.
  • 1,653 View
  • 11 Download
AbstractAbstract PDF
Although a majority of patients with splenic rupture present acutely, up to 15% present with a delayed rupture days to weeks following a substantial abdominal injury. The mortality for patients presenting with acute splenic rupture is approximately 1% whereas that associated with delayed rupture approaches 15%. Although many cases of delayed splenic rupture have been reported, the majority of those reports present delayed splenic rupture associated with an underlying systemic disorder such as liver or kidney disease, or another hematologic disorder. We found a delayed splenic rupture case that documented the normal spleens of young healthy soldiers after trivial abdominal trauma, and we have had successful treatment experience with delayed rupture of a normal spleen after trivial trauma. Therefore, we want to review the literature and discuss the phenomenon of delayed rupture of the spleen following trivial trauma.
Summary
J Trauma Inj : Journal of Trauma and Injury
© The Korean Society of Traumatology.
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