Humans ; Spleen ; injuries ; physiology ; surgery ; Splenectomy

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*

Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.
Abdominal Injuries ; complications ; Adult ; Asymptomatic Diseases ; Humans ; Male ; Spleen ; injuries ; Splenectomy ; Splenosis ; diagnosis ; etiology ; pathology ; surgery ; Thoracic Diseases ; diagnosis ; etiology ; pathology ; surgery ; Thoracic Injuries ; complications ; Thoracotomy ; Unnecessary Procedures

OBJECTIVETo investigate the indication of non-operative management of adult blunt splenic injuries.

METHODSA retrospective review was performed on all adult patients (age>15 years) with blunt splenic injuries admitted to the department of vascular surgery of Pellegrin hospital in France from 1999 to 2003. We managed splenic injuries non-operatively in all appropriate patients without regard to age.

RESULTSDuring the 4 years, 54 consecutive adult patients with blunt splenic injuries were treated in the hospital. A total of 27 patients with stable hemodynamic status were treated non-operatively at first, of which 2 patients were failed to non-operative treatment. The successful percentage of non-operative management was 92.6%. In the 54 patients, 7 of 8 patients older than 55 years were treated with non-operative management. Two cases developing postoperatively subphrenic infection were healed by proper treatment. In the series, there was no death.

CONCLUSIONSNon-operative management of low-grade splenic injuries can be accomplished with an acceptable low-failure rate. If the clinical and laboratory parameters difficult for surgeons to make decisions, they can depend on Resciniti's CT (computed tomography) scoring system to select a subset of adults with splenic trauma who are excellent candidates for a trial of non-operative management. The patients older than 55 years are not absolutely inhibited to receive non-operative management.

Adolescent ; Adult ; Aged ; Female ; Hematocrit ; Humans ; Male ; Middle Aged ; Multiple Trauma ; therapy ; Retrospective Studies ; Spleen ; injuries ; surgery ; Wounds, Nonpenetrating ; surgery ; therapy

We present a case of thoracic splenosis in a 42-yr-old man with a medical history of abdominal surgery for a penetration injury with an iron bar of the left abdomen and back. He had been in good condition, but a chest radiograph taken during a regular checkup showed a multinodular left pleura-based mass. Computed tomography (CT) showed that the mass was well-enhanced and homogeneous, indicating a sclerosing hemangioma. Following its removal by video-assisted thoracoscopic surgery, the mass appeared similar to a hemangioma, with marked adhesion to the left side diaphragmatic pleura and lung parenchyma. Frozen section showed that the lesion was a solid mass consisted with abundant lymphoid cells, suggesting a low grade lymphoma. On permanent section, however, the mass was found to be composed of white pulp, red pulp, a thick capsule and trabeculae and was diagnosed as ectopic splenic tissue, or thoracic splenosis. Review of the patient's history and chest CT at admission revealed that the patient had undergone a splenectomy for the penetration injury 20 yr previously.
Abdominal Injuries/complications ; Adult ; Diagnosis, Differential ; Humans ; Male ; Medical Records ; Spleen/injuries/surgery ; Splenectomy ; Splenosis/*diagnosis/etiology/radiography ; Thoracic Diseases/*diagnosis/etiology/radiography ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

OBJECTIVETo observe the in vivo colonization, migration, and differentiation of in vitro cultured human fetal hepatic stem cells (HSCs) following intrasplenic transplantation for treatment of acute liver injury in mice with severe combined immunodeficiency (SCID).

METHODSHuman fetal HSCs were isolated from the normal fetal liver (16-24 weeks) and purified, and the morphology of HSCs was observed under optical and transmission electron microscopes. The expressions of stem cell markers were examined in these HSCs by means of immunocytochemistry and flow cytometry. The passaged human fetal HSC suspension (0.2 ml) were injected into the spleen of SCID mice with acute liver injury induced by two-third partial hepatectomy, and 15, 30, 60, and 90 days after cell transplantation, immunohistochemistry was performed to examine the location and expressions of human hepatocytes, alpha1-AT and AFP antigen in the spleen and liver of the recipient SCID mice. PAS staining was used to examine the expression of glycogen and RT-PCR employed for detection of the expressions of AFP and albumin mRNA in the spleen of the mice on the scheduled time points.

RESULTSUnder optical microscope and transmission electron microscope, most of the HSCs were small, about 1/6 to 1/3 of the size of the hepatocyte, with relatively large nucleus-cytoplasm ratio and only small quantities of endocytoplasmic reticulum, chondriosome, and ribosome. Immunohistochemistry and flow cytometry identified positive expressions of AFP, Thy-1, C-kit, CD34 and CK19 in the HSCs, and after cell transplantation, positive expressions of human hepatocyte, alpha1-AT, and AFP antigen occurred in the liver and spleen of the recipient SCID mice. PAS staining confirmed the presence of glycogenosome in the spleen of the mice following cell transplantation. RT-PCR on days 30, 60, and 90 showed positive expressions of human AFP and albumin mRNA in the spleen of the mice.

CONCLUSIONHuman fetal HSCs can survive and settle in the spleen and liver, and migrate to the damaged liver of the recipient mice after intrasplenic transplantation, with the capacity of proliferation and differentiation into hepatocytes in the recipient target organs.

Animals ; Cells, Cultured ; Female ; Fetal Stem Cells ; cytology ; transplantation ; ultrastructure ; Flow Cytometry ; Hepatectomy ; methods ; Hepatocytes ; cytology ; metabolism ; transplantation ; Humans ; Immunohistochemistry ; Liver ; injuries ; surgery ; Mice ; Mice, Inbred BALB C ; Mice, SCID ; Microscopy, Electron, Transmission ; Reverse Transcriptase Polymerase Chain Reaction ; Spleen ; metabolism ; surgery ; Stem Cell Transplantation ; methods ; Transplantation, Heterologous ; alpha-Fetoproteins ; analysis ; genetics