RESUMEN
BACKGROUND: Contained in-bag spleen morcellation is a conventional extraction technique for safe spleen removal during laparoscopic splenectomy. Existing data for the use of in-bag enzymatic splenic digestion as an alternative to morcellation are lacking. This proof-of-concept study sought to evaluate the effectiveness of single and combinatorial enzyme digestion of murine spleens. MATERIALS AND METHODS: Murine spleens were digested with collagenase alone or with combinations of commercially available enzymes (collagenase, elastase, hyaluronidase, neutral protease) to determine their degradation effect. The primary end point was the percentage of mass reduction at 15 and 30 min. RESULTS: For collagenase alone (n = 15), the mean reduction in mass was 14 ± 10% (range: 2%-31%) at 15 min and 30 ± 25% (range: 7%-100%) at 30 min. Using combinatorial dissolution with collagenase, hyaluronidase, and elastase (n = 8), the mean reduction in mass was 27 ± 16% (range: 6%-42%) at 15 min and 48 ± 27% (range: 3%-100%) at 30 min. Injecting the enzyme solution into whole spleens (n = 9) yielded a mean reduction in mass of 22 ± 13% (range: 9%-42%) at 15 min and 55 ± 31% (range: 9%-100%) at 30 min; mean reduction was 9 ± 13% (range: 0%-39%) at 15 min and 23 ± 13% (range: 3%-53%) with no injection (n = 12). CONCLUSIONS: We provide the first demonstration of successful enzymatic murine spleen digestion as an alternative method for in-bag spleen removal during laparoscopic splenectomy. However, the significant cost and quantities of commercial enzyme required for clinical application dampens the enthusiasm for this novel approach.
Asunto(s)
Esplenectomía/métodos , Animales , Enzimas , Ratones Endogámicos C57BL , Procedimientos Quirúrgicos Mínimamente InvasivosAsunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/microbiología , Edwardsiella tarda/aislamiento & purificación , Infecciones por Enterobacteriaceae/microbiología , Hepatitis C Crónica/complicaciones , Choque Séptico/microbiología , Animales , Programas de Optimización del Uso de los Antimicrobianos , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bagres/microbiología , Enfermedad Crítica , Edwardsiella tarda/efectos de los fármacos , Infecciones por Enterobacteriaceae/diagnóstico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Choque Séptico/diagnóstico , Choque Séptico/tratamiento farmacológicoRESUMEN
Pneumatosis intestinalis and gastric pneumatosis are rare, but potentially morbid conditions in the burn-injured patient. They present a pediatric patient with severe scald injuries and isolated gastric pneumatosis who was successfully treated with a multidisciplinary approach and nonoperative management.