O-EGS07 Early initiation of biochemical venous thromboembolism prophylaxis following traumatic spleen injury is safe and effectively reduce VTE events

Background The standard of care for managing patients with traumatic splenic injuries (TSI) has become non operative management (NOM)1,3,4, but the safe window initiating chemical venous thromboembolism (VTE) prophylaxis, heparin or low molecular weight heparin (LMWH), is not well established 2. Within the first 48h from injury, hyper-coagulation state occurs which put trauma patients at risk of developing deep vein thrombosis(DVT), pulmonary embolism (PE) and lead to an increase rate in mortality 5,6. This study examines the safety and timing initiating VTE prophylaxis post splenic injury. Methods Patients with TSI were identified from prospectively maintained Trauma Audit and Research Network (TARN) database from 2015-2020 in a single tertiary trauma centre. Clinical and radio-logical information were collected retrospectively. TSI were graded using American Association for the Surgery of Trauma (AAST) splenic injury scale. Chemical venous thromboprophylaxis initiation were categorised as not given, <48h and >48h following the injury. Results In total 102 patient were included out of 136 patients identified with TSI. 34 patients were excluded for lack of electronic data, palliative decision or fatal condition on arrival. 12 patients out of 102 required operative management (OM) and 90 patients NOM. VTE prophylaxis was not given for 31 (30.4%). Medical reasons for this include severe brain injury and early discharge before 48 hours. VTE prophylaxis was initiated for 37 (36.3%) patients within 48 hours, and for 34 patients (33.3%) after 48 hours of admission. Seven patients developed thromboembolic events, majority of which (6/7) received VTE prophylaxis after 48 hours. Importantly, none of the patients who received VTE prophylaxis had rebleeding. Conclusions This study showed that early initiation of chemical VTE prophylaxis (<48h) is safe, resulted in lower incidence of DVTs/PEs without increasing the risk of bleeding. Results from this study supports recommendation from other studies 1 to initiate chemical VTE prophylaxis after TSI as early as 24h post injury with no other contra-indications

Transarterial embolization for traumatic splenic injury in a patient with a variant origin of splenic artery from the proper hepatic artery

A 57-year-old male patient was diagnosed with grade 2 spleen laceration and other multiple organ injuries after a rollover car accident. The patient was hemodynamically stable. Thus, transarterial embolization was performed to the splenic artery (SA). In angiography, the patient’s SA arised from a proper hepatic artery. The embolization finished successfully and the patient was discharged from the hospital on day 12 without any complications. Transarterial SA embolization may be feasible in patients who have varying SA origins even though the procedure is technically more challenging and a longer catheter may be needed compared to those of the usual case.

The Utility of Serial Hemoglobin Monitoring in Non-Operative Management of Blunt Splenic Injury

Background The Eastern Association for the Surgery of Trauma (EAST) states there is not enough evidence to recommend a particular frequency of measuring Hgb values for non-operative management (NOM) of blunt splenic injury (BSI). This study was performed to compare the utility of serial Hgb (SHgb) to daily Hgb (DHgb) in this population. Methods We conducted a retrospective chart review of patients with BSI between 2013 and 2019. Demographics, comorbidities, lab values, clinical decisions, and outcomes were gathered through a trauma database. Results A total of 562 patients arrive in the trauma bay with BSI. In the NOM group, 297 were successful and 37 failed NOM. Of those that failed NOM, 8 (21.6%) changed to OM due to a drop in Hgb. 5 (62.5%) were hypotensive first, 2 (25%) were no longer receiving SHgb, and 1 (12.5%) had a repeat CT scan and was embolized. DHgb patients were not significantly different from SHgb patients in injury severity, length of stay, the largest drop in Hgb, and incidence of failing NOM. Patients taking aspirin were more likely to fall below 7 g/dl at 48 and 72 hours into admission. Conclusions These results suggest that that trending SHgb may not influence clinical decision-making in NOM of BSI. Besides taking aspirin, risk factors for who would benefit from SHgb were not identified. Patients who received DHgb had similar injuries and outcomes than patients who received SHgb. Prospective studies are needed to evaluate the clinical utility of SHgb compared to DHgb.

Delayed splenic rupture and conservative management: case series

Splenic injury is frequent in patients with abdominal trauma and delayed splenic rupture yields a poorer prognosis. Patients with hemodynamic stability, despite the grade of splenic anatomical injury, can be safely treated by conservative management (observation or angiography/angioembolization), if no other intra-abdominal injuries are found and a multidisciplinary team (surgeons, interventional radiologists) is available. The conservative approach is an alternative to surgery and its possible complications. In this case series, the authors present three trauma cases very commonly seen in emergency rooms, in whom delayed splenic rupture was diagnosed. All three patients were submitted to conservative management, with no need for surgery or complications. This case series presents some common clinical signs and diagnostic steps, also showing the safety and efficacy of clinical observation in this setting.

Successful anesthetic management in a case of grade V splenic injury in covid 19 positive patient: A case report

Splenic injuries are amongst the most frequent trauma-related injuries which requires emergency surgeries demanding meticulous surgical and anesthetic management. The aim while managing splenic trauma patients, is to restore homeostasis and normal pathophysiology in the body by achieving hemostasis with an emergency splenectomy. To date, there have been few reports describing the anaesthetic management of COVID-19 patients presenting for emergency surgery. In this article, we outline the anaesthetic management for a case with hemoperitoneum, posted for emergency exploratory laparotomy and splenectomy in our operating theatre who was incidentally diagnosed to be COVID positive in the emergency unit by a rapid antigen test.

Clinical review of splenic trauma in central India: a prospective observational study

Background: Spleen is one of the most commonly injured intra-abdominal solid organs. If undiagnosed in earlier stage patient may even present with shock. Even though management depend on grade on splenic injury, primary goal remains stabilizing the patient. The operative interventions are done by open or laparoscopic technique which may be splenorrhaphy or splenectomy.Methods: A prospective observational study on 52 patients with splenic injury was performed. The study period was 27 months. Patients with clinical and radiological signs of splenic trauma were categorised and operative/ non-operative treatment was given as per protocol. The surgical and nonsurgical outcomes were evaluated during inpatient stay and follow-up was kept.Results: Fifty-Two patients were analysed comprising 36 male and 16 females. Most common mode of injury was road traffic accident followed by falls. Grade III injury was commonest, while rib fracture was commonest associated injury. Pneumonia was a frequent complication postoperatively.Conclusions: Splenic injury is a real threat after blunt abdominal trauma in young population. Vaccination and equalae of OPSI (Overwhelming post splenectomy infection) must be kept always in mind after splenectomy. Splenic trauma diagnosed early and treated immediately can save the patient’s life.