Background: Nonoperative treatment of blunt splenic injury in children has become routine standardization in Viet Nam. Objectives:This study aims to study the efficacy of nonoperative management (NOM) for blunt splenic injury (BSI) in children. Subjects and method: The records of all the patients treated in National Hospital of Pediatrics with final diagnosis blunt splenic injury between January 2000 and December 2006 were reviewed. The clinical signs, investigations, imaging studies, methods of treatment and results were analyzed. The splenic injuries were graded according to the American Association for the Surgery of Trauma (AAST). Results:There were 15 patients from one day to 12 years of age, with average injury grade 2.2. From 13 patients who were attempted NOM, only 2 patients (blunt liver injury - BLI grade 3 and 4) were operated thereafter because of continuing bleeding or worsening clinically, the remains of 12 recovered well with average hospitalized duration wasf 6 days. The NOM for BLI was successful in 11/13 (84.6%) in our series. Conclusion:NOM was highly efficient method and should be the standard initial approach for all the children with BLI. These patients must be closely monitored for prompt surgical treatment in case of NOM failure.
Spleen/ injuries ; Infant

Background: Pediatric closed abdominal trauma is a common disease in surgical practice, in which spleen is the most vulnerable organ. As adults, diagnosis of pediatric splenic trauma is not difficult but treatment attitude of splenic trauma in children having more important differences compared with in adults, tending to conservative treatment without surgery. Objectives: To assess the results of pediatric splenic trauma treatment in Hue Central Hospital from 2001 to 2005. Subjects and method: To study on 43 pediatric patients (23 male, 20 female), mean age 11.35\xb13.51 years, were diagnosed with splenic trauma due to closed abdominal trauma, treated in Hue Central Hospital from September, 2001 to September, 2006. Results: 72.1% hospitalized patients with maximum blood pressure in normal limitation. There was not a statistic significant association between hypotension and indicated surgery. The rate of patients with splenic trauma due to traffic accidents, living accidents and sport activities were 62.8%, 32.6% and 4.7%, respective. 2 patients with combined traumatic brain injury without surgery (4.65%), 3 patients with combined hand fracture (6.97%). 3 patients in conservative treatment group changed to surgery (8.33%). A total of 76.7% patients treated with successful conservation. Conclusion: More than 60% patients with splenic trauma caused by traffic accidents and having stable hemodynamic index during hospitalization. The difference between position of splenic trauma and rupture degree of spleen both in surgical treatment group and successful conservative treatment group is statistically significant.
Spleen/ injuries ; Child ;

Humans ; Spleen ; injuries ; physiology ; surgery ; Splenectomy

Delayed splenic rupture is a rare complication of blunt abdominal trauma in which the time interval from injury to splenic rupture is > 48 hours. The diagnosis can be challenging if the history of trauma is remote, or initially missed, because symptoms may present subtly and without classic historical associations. We report a case of delayed rupture of the spleen from remote, minor trauma that required an emergency splenectomy.
Abdominal Injuries ; Emergencies ; Rupture ; Spleen ; Splenectomy ; Splenic Rupture

OBJECTIVEDetection of abdominal injury is a very important component in trauma management, so a precise assessment of liver and spleen injuries including their severity degree is necessary. There is a good case to believe that in emergency situations the radiologists' performance may profit from a systematic approach using established scoring systems. Score systems as the organ injury scale (OIS) drawn up by the American Association for the Surgery of Trauma are a valuable guidance for objective trauma assessment. Aim of this study was to evaluate retrospectively whether a structured approach using the OIS may help improve trauma assessment.

METHODSFifty-three patients, 38 male and 15 female who underwent CT and laparotomy after abdominal trauma were included in this study. The laparotomy was performed by experienced surgeons with a minimum experience of 6 years. While the original CT reports were written by different radiologists with a minimum experience of 3 years, and then a radiologist with experience of 4 years reviewed the same original CT pictures, resulting in the structured report. Both the original and structured CT results on liver and spleen injuries were transferred into OIS grades. Finally, the initial and structured CT results were compared with the intraoperative findings gathered from the surgery report.

RESULTSRegarding the original CT report we found a mean divergence of 0.68 ± 0.8 (r=0.45) to the OIS finding in the surgery report for liver injuries (0.69 ± 1.17 for spleen injuries; r=0.69). In comparison with the structured approach, where we detected a divergence of 0.8 ± 0.68; r=0.63 (0.47 ± 0.77 for spleen injuries; r=0.91), there was no significant difference. However we detected a lower rate of over-diagnosis in structured approaches.

CONCLUSIONOur study shows that a structured approach to triage abdominal trauma using an imaging checklist does not lead to a significantly higher detection rate, but a nonsignificant trend to reduce the rate of over-diagnoses, thus being more precise in grading the severity grade. Concerning the bias by retrospective study design, further prospective investigations are needed to evaluate the impact of trauma scores on the workflow in emergency department procedure as structured reporting systems are a valuable guidance in other radiological disciplines.

Adult ; Female ; Humans ; Liver ; diagnostic imaging ; injuries ; Male ; Radiography ; Retrospective Studies ; Spleen ; diagnostic imaging ; injuries ; Trauma Severity Indices

The philosophy of abdominal injury management is currently changing from mandatory exploration to selective non-operative management (NOM). The patient with hemodynamic stability and absence of peritonitis should be managed non-operatively. NOM has an overall success rate of 80%-90%. It also can reduce the rate of non-therapeutic abdominal exploration, preserve organ function, and has been defined as the safest choice in experienced centers. However, NOM carries a risk of missed injury such as hollow organ injury, diaphragm injury, and delayed hemorrhage. Adjunct therapies such as angiography with embolization, endoscopic retrograde cholangiopancreatography with stenting, and percutaneous drainage could increase the chances of successful NOM. This article aims to describe the evolution of NOM and define its place in specific abdominal solid organ injury for the practitioner who faces this problem.
Abdominal Injuries/surgery* ; Angiography ; Humans ; Injury Severity Score ; Laparotomy ; Probability ; Retrospective Studies ; Spleen/injuries* ; Wounds, Nonpenetrating/therapy*

PURPOSE: Rib fracture is a common injury seen in traumatized patients. It can be frequently correlated with concomitant AOI (abdominal organ injury). This study was designed to assess the factors increasing the risk of concomitant AOI. METHOD: We reviewed retrospectively the medical charts of 166 rib-fracture blunt-trauma patients. Data were collected on age, sex, the vectors of injury, the rib-fracture location, the presence of a pneumothorax or a hemothorax, and the presence injury to the abdominal organs. RESULT: The total number of AOI cases correlated with rib fractures was 36 (21.7%). The most frequently injured organ was the liver (13 cases). The probability of AOI increased with the presence of any low-rib fracture. Also, the probability of splenic injury increased with the presence of left-sided rib fracture. There was no difference in the incidence of AOI-correlated pneumo- or hemothorax. CONCLUSION: Low-rib fracture increases the risk of AOI as were taught traditionally. The most commonly injured organ was the liver. Injury to the spleen was correlated with the location of the fracture, especially the left side.
Abdominal Injuries ; Hemothorax ; Humans ; Incidence ; Liver ; Pneumothorax ; Retrospective Studies ; Rib Fractures* ; Ribs* ; Spleen

The abdomen includes the organs and viscera below the diaphragm and above the pelvic girdle. Although there is little bony structure to protect these organs from blunt impact, injuries to this region is relatively rare. Like the thorax, the abdomen can be the site of injuries sustained by inner parts of the car and restraint systems. As far as the crucial organs are concerned, the liver, spleen and kidneys are most frequently injured, and it seems to be the most serious and life-threatening. Injury mechanisms of the abdomen are thought to be primarily the result of deformation or penetration of the abdominal contents along with significant force or pressure generation in the deformed organs. In addition, solid organs, such as liver may undergo severe damage due to pressure generation alone at high impact velocities. There is evidence to show that these organs are viscoelastic, that the rate of loading is a crucial factor in injury causation, and that a compressive stress of 310kPa(45psi) will cause a superficial liver injury. Regarding dynamic response of the abdomen, the problem is complicated by the fact that there is a variety of surface geometries and component materials that can impact the abdominal area in a vehicle crash environment. In side impacts, however, the surface such as doors and armrests are somewhat well-defined, and dynamic load-deflection response curves do exist to a limited extent.
Abdomen ; Abdominal Injuries* ; Accidents, Traffic* ; Diaphragm ; Kidney ; Liver ; Spleen ; Thorax ; Viscera

OBJECTIVETo study the role of contrast-enhanced ultrasound (CEUS) in the management of splenic trauma

METHODSForty patients with splenic trauma underwent CEUS examination and then different management were provided according to the examination results and the general status of patients: conservative treatment (group I, n = 19); CEUS-guided injective therapy (group II, n = 6); and surgery (group III, n = 15).

RESULTSEighteen patients were cured in group I and one patient experienced rehaemorrhagia. The haemostatic effect of CEUS-guided injective therapy was obvious in all six patients in group II. Among them, one patient experienced arteriovenous fistula, which was resolved after one week of injective therapy. Fifteen patients in Group III underwent surgery and were cured.

CONCLUSIONCEUS can provide reliable information for therapy mode selection in patients with splenic trauma and can be used to guide injective therapy.

Contrast Media ; Humans ; Spleen ; diagnostic imaging ; injuries ; Ultrasonography ; Wounds, Nonpenetrating ; diagnostic imaging ; therapy

OBJECTIVETo evaluate the sensitivity and specificity of CT scan findings in patients with blunt abdominal trauma admitted to the university hospital.

METHODSAll the patients with blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study. In the absence of any clinical manifestations, the patients underwent a diagnostic CT scan. Laparatomy was performed in those with positive CT results. Others were observed for 48 hours and discharged in case no problem was reported; otherwise they underwent laparatomy. Information on patients?demographic data, mechanism of trauma, indication for CT scan, CT scan findings, results of laparotomy were gathered. The sensitivity, specificity and accuracy of the CT-scan images in regard with the organ injured were calculated. The sensitivity, specificity and accuracy of the CT scan were calculated in each case.

RESULTSCT scan had the highest sensitivity for detecting the injuries to liver (100%) and spleen (86.6%). The specificity of the method for detecting retroperitoneal hematoma (100%) and injuries to kidney (93.5%) was higher than other organs. The accuracy of CT images to detect the injuries to spleen, liver, kidney and retroperitoneal hematoma was reported to be 96.1%, 94.4%, 91.6% and 91.6% respectively.

CONCLUSIONThe findings of the present study reveal that CT scan could be considered as a good choice, especially for patients with blunt abdominal trauma in teaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts.

Abdominal Injuries ; diagnostic imaging ; Adolescent ; Adult ; Child ; Female ; Humans ; Liver ; injuries ; Male ; Middle Aged ; Sensitivity and Specificity ; Spleen ; injuries ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating ; diagnostic imaging ; Young Adult