[Rupture of the spleen in angiosarcoma: a case report and review of the literature]. / Rottura di milza in angiosarcoma: considerazioni su di un caso clinico e revisione della letteratura.

Splenic angiosarcoma is a rare neoplasm originating from endothelial cells of the blood vessels. Its incidence is about 0.14-0.25 per million. We report the case of a patient admitted in a state of hypovolaemic shock with haemoperitoneum due to rupture of the spleen. Splenectomy was performed with evacuation of the haemorrhagic effusion. The blood was aspirated and in part instilled during the operation through intraoperative blood salvage due to the large haemoperitoneum. Histological examination revealed a splenic angiosarcoma. Splenic angiosarcoma should be suspected in cases of splenomegaly with unknown anaemia and no lymphoma, leukaemia or myelofibrosis, because of its neoplastic aggressiveness and its invariably fatal outcome. It is important to perform a splenectomy before splenic rupture owing to its negative impact on long-term survival.

[Radiofrequency coagulation for splenic resection--a case report]. / Die Radiofrequenz-Koagulation bei der nicht-anatomischen Resektion der Mil--Ein Fallbericht.

Radiofrequency ablation is used in our Department of Surgery in cases of unresectable liver tumors. The case of a 22-year old male, who underwent nonanatomical resection of the spleen for trauma, is briefly reported. Splenic resection with the use of the radiofrequency needle could be performed safely and easily without complications. We use radiofrequency coagulation routinely in cases of blunt trauma of the spleen and liver.

Alternativas quirúrgicas a la esplenectomía postraumática, procedimientos de rescate esplénico en población pediátrica / Alternative procedures to splenectomy in pediatric population

Antecedentes: Hace cuatro décadas las normas del Departamento de Cirugía de nuestro Hospital, establecían esplenectomizar a los niños con bazos dañados, destacando que estas disposiciones eran reglas quirúrgicas con consenso mundial. Las graves complicaciones infecciosas, condujeron a desarrollar estrategias que permitieron realizar tratamientos quirúrgicos conservadores aun ante graves traumatismos. Objetivo: Conocer una serie de procedimientos alternativos a la esplenectomía, ya que la misma en pediatría conlleva un elevado riesgo de morbi-mortalidad por sepsis, sobre todo en menores de 5 años. Lugar de aplicación: Hospital de Niños Ricardo Gutierrez (HNRG) de Buenos Aires, Argentina. Diseño: Trabajo retrospectivo, observacional, no comparativo y cerrado. Población: Se trata de un grupo de 6 niños con lesiones esplénicas graves. Método: Fueron tratados mediante un protocolo normatizando en base a los criterios de atención inicial del curso ATLS del Colegio Americano de Cirujanos y el Comité de Trauma del HNRG. Para valorar el grado de lesión esplénica se utilizó el Organ Injury Scale OIS-(Spleen Injury Scale) y se categorizó la severidad de las lesiones utilizando el Abreviated Injury Scale 90. Resultados: Las cirugías realizadas (procedimientos operatorios alternativos a la esplenectomía), fueron las siguientes: 3 encestes con Vicryl Mesh, 2 ligaduras arteriales y 1 envoltura esplénica con parche de epiplón y bañado con adhesivo tisular. Todos los pacientes evolucionaron favorablemente. Conclusiones: En pediatría los traumatismos cerrados a nivel abdominal, en raras ocasiones requieren laparotomía, pero cuando esto sucede es recomendable que el cirujano maneje un amplio repertorio de técnicas quirúrgicas conservadoras y trabaje empeñado en no resecar el bazo, especialmente en niños menores de 5 años

Alternativas quirúrgicas a la esplenectomía postraumática, procedimientos de rescate esplénico en población pediátrica / Alternative procedures to splenectomy in pediatric population

Antecedentes: Hace cuatro décadas las normas del Departamento de Cirugía de nuestro Hospital, establecían esplenectomizar a los niños con bazos dañados, destacando que estas disposiciones eran reglas quirúrgicas con consenso mundial. Las graves complicaciones infecciosas, condujeron a desarrollar estrategias que permitieron realizar tratamientos quirúrgicos conservadores aun ante graves traumatismos. Objetivo: Conocer una serie de procedimientos alternativos a la esplenectomía, ya que la misma en pediatría conlleva un elevado riesgo de morbi-mortalidad por sepsis, sobre todo en menores de 5 años. Lugar de aplicación: Hospital de Niños Ricardo Gutierrez (HNRG) de Buenos Aires, Argentina. Diseño: Trabajo retrospectivo, observacional, no comparativo y cerrado. Población: Se trata de un grupo de 6 niños con lesiones esplénicas graves. Método: Fueron tratados mediante un protocolo normatizando en base a los criterios de atención inicial del curso ATLS del Colegio Americano de Cirujanos y el Comité de Trauma del HNRG. Para valorar el grado de lesión esplénica se utilizó el Organ Injury Scale OIS-(Spleen Injury Scale) y se categorizó la severidad de las lesiones utilizando el Abreviated Injury Scale 90. Resultados: Las cirugías realizadas (procedimientos operatorios alternativos a la esplenectomía), fueron las siguientes: 3 encestes con Vicryl Mesh, 2 ligaduras arteriales y 1 envoltura esplénica con parche de epiplón y bañado con adhesivo tisular. Todos los pacientes evolucionaron favorablemente. Conclusiones: En pediatría los traumatismos cerrados a nivel abdominal, en raras ocasiones requieren laparotomía, pero cuando esto sucede es recomendable que el cirujano maneje un amplio repertorio de técnicas quirúrgicas conservadoras y trabaje empeñado en no resecar el bazo, especialmente en niños menores de 5 años (AU)

Multimodality management in severe pediatric spleen trauma.

BACKGROUND: Trauma is the leading cause of death in children. In abdominal lesions the spleen is the most commonly involved organ. During the last two decades much effort has focused on spleen tissue conservation. OBJECTIVES: To analyze the rationale of a multimodality management policy that includes autotransfusion and mesh wrapping. METHODS: Data gathered over 14 years illustrate the introduction of new techniques and their impact on cases of severe spleen rupture. RESULTS: A total of 122 children were treated during the 14 year period, 1985-98. In 16 children an absorbable mesh wrapping, alone or in combination with other techniques, was used to obtain hemostatis and save spleen tissue. CONCLUSIONS: Mesh wrapping, partial splenectomy and autotransfusion can be used, alone or in combination, to preserve severely injured spleens. According to our records, all children survived with a functional spleen. There were no cases of rebleeding. In only one case of prolonged postoperative fever could the cause be traced to an infected spleen hematoma that was drained transcutaneously. Autotransfusion is performed simply and without the use of a "cell saver." Its use can be crucial in small or field hospitals or in a situation of mass casualty.

[The use of laparoscopy in the diagnosis of a traumatic lesion of the spleen]. / Primenenie laparoskopii v diagnostike tramaticheskogo povrezhdeniia selezenki.

The results of laparoscopic diagnosis of splenic rupture in the closed abdominal trauma in 80 injured persons were analyzed. A splenic damage was excluded in 38 patients. In 12 of them hematoma, serohemorrhagic exudate, intestinal paresis were revealed. One patient with duodenal rupture was operated on, and in one more patient the idle laparotomy was conducted. Five patients died. According to the laparoscopic data a splenic rupture was diagnosed in 35 injured persons. Diagnostic failure was conceded in one patient, in whom a hepatic rupture was revealed while the laparoscopy conduction. A successful conservative treatment was conducted in three patients for subcapsular splenic hematoma. Relaparotomy conduction was needed in 3 patients. Three patients died: two of them--due to severe polytrauma and one--due to bronchopneumonia. One else patient died, which was hospitalized with severe polytrauma. In one patient bronchospasm have occurred.

[Autotransfusion: its use in a case of spontaneous splenic rupture in non-Hodgkin's lymphoma]. / Autotrans: sua utilizzazione in un caso di rottura spontanea di milza in linfoma non Hodgkin.

The article refers to autotransfusion experience in a patient affected by lymphoma (not Hodgkin type), who reached surgery for haemoperitoneum caused by the spontaneous rupture of the spleen. Considering the pathology, this method brought unpredictable variations in the hemochrome thus leading to a deep reflection on the limitations of the use of autotransfusion.

Autotransfusion in splenic rupture.

Different methods of autotransfusion have been employed by various people in various places for various reasons. In Papua New Guinea autotransfusion has been practised, but the methods used have not been described and illustrated. In this case presentation we illustrate a simple inexpensive and aseptic method that was used at the Tabubil Health Centre to autotransfuse a young local man who ruptured his enlarged spleen when he was involved in a motor vehicle accident in August 1991. The advantages of this method are mentioned. Also mentioned are other expensive methods of autotransfusion used in developed countries, and some surgical procedures in which these methods have been used.

[Autohemotransfusion in patients with intraperitoneal hemorrhage. Report of 221 cases].

Autohemotransfusion was performed in 221 patients with intraperitoneal hemorrhage. The total amount of blood autotransfused was 198,760 ml, accounting for 90% of whole the blood transfused during the operations. The average amount of blood transfused was 899 ml per case, the largest amount being 3600 ml. There was no any adverse reaction observed. We consider that autohemotransfusion may avoid some shortcomings of donor's blood, and is of great importance in the treatment of patients with hemorrhagic shock when bank blood is not immediately available. The indications and contraindications of autohemotransfusion are discussed.

[Subjective sequelae of splenectomy]. / Die subjektiven Folgen des Milzverlustes.

111 of 806 former patients splenectomized at the Würzburg university hospital during the years 1968-1983 were interviewed for their complaints since their operation. Investigations included the use of Beck's inventory for measuring depression and the Giessen questionnaire for the evaluation of general complaints used in psychosomatic medicine. There was a significant increase of symptoms after splenectomy as compared to the normal population. A special list of 18 questions to investigate typical postsplenectomy complaints was answered by 95 of these 111 persons and by a control group of "statistical twins" with similar upper abdominal surgery without splenectomy. The leading difference was the highly significant increase of the susceptibility to infections after splenic loss followed by accelerated exhaustion and increased physical and mental weakness. The distribution of other complaints like for instance the intolerance to alcohol hitherto judged as typical sequelae of splenectomy was not statistically different in both splenectomy was not statistically different in both groups. Since the symptoms listed above as significantly increased in the splenectomized patient were closely correlated with the susceptibility to infection they seem to be rather the expression of the decreased resistance than direct consequences of the loss of the spleen.

[Non-operative treatment of splenic rupture: clinical analysis of 76 cases].

Among 79 cases of splenic rupture, 76 were treated with non-operative treatment since 1980, with interval splenectomy in 1 case. All the patients were cured. The diagnosis was based on history, hemoperitoneum, diagnostic abdominocentsis, ultrasonic scanning, endoscopy, and X-ray with examination contrast media. The medical measures included bed rest, gastric decompression, blood volume replenishment, autotransfusion and Chinese medicine. Both children and adults suffering from splenic rupture can be treated with nonoperative treatment in selected cases.

[Closed injuries of the spleen]. / Zakrytye povrezhdeniia selezenki.

The 10-year experience with diagnosis and treatment of closed injuries to the spleen in 84 patients is presented. In 13 patients, the two-instant splenic rupture, in 5--spontaneous was noted. Seventy (83.3%) patients had isolated injuries. In 17 patients, blood reinfusion with total volume of 22,800 ml was performed at operation. Post-operative lethality was 4.8%, total--5.9%. One patient died without operation.

Nuclear medicine and complementary modalities in renal trauma.

The diagnosis of renal trauma for many years was achieved through history, clinical findings, the performance of a survey film of the abdomen, urinalysis, excretory urography, aortography, and selective renal artery arteriography. The development of the scintillation camera and the availability of 99mTc, as well as 99mTc labeled pharmaceuticals, approximately fifteen years ago has widened this diagnostic horizon. Exquisite new imaging modalities have become available recently. As a result of constantly improving technology, these techniques--including computed tomography, sonography, with real time enhancement, and digital video subtraction angiography--are utilized more and more frequently. The full impact of these newest wonders is not yet realized. Cost-effectiveness, radiation exposure, accumulative drug side-effects, availability of facilities and personnel and professional and technical training have become major considerations.

[Organ-preserving procedure and blood retransfusion in children with splenic ruptures]. / Ob organosokhraniaiushchei taktike i retransfuzii krovi u detei s razryvami selezenki.

An analysis of anesthesiologic and surgical tactics in the treatment of children with spleen traumas proves the reliability and effectiveness of the blood retransfusion and of the principle of the organ-preserving interventions, according to the amount of the blood loss and the character of the spleen ruptures. In authors' opinion splenectomy is indicated in total crush of the spleen and the detachment of its vascular pedicle. There were no fatal outcomes.