The nonoperative management of traumatic spleen injuries is the modality of choice in patients with blunt abdominal trauma and hemodynamic stability. However, there are still questions about the treatment indication in some groups of patients, as well as its follow-up.
Update knowledge about the spleen injury.
Was performed review of the literature on the nonoperative management of blunt injuries of the spleen in databases: Cochrane Library, Medline and SciELO. Were evaluated articles in English and Portuguese, between 1955 and 2014, using the headings "splenic injury, nonoperative management and blunt abdominal trauma".
Were selected 35 articles. Most of them were recommendation grade B and C.
The spleen traumatic injuries are frequent and its nonoperative management is a worldwide trend. The available literature does not explain all aspects on treatment. The authors developed a systematization of care based on the best available scientific evidence to better treat this condition.
Splenic infarction is an uncommon cause of acute abdomen4. Causes include hematologic disease (such as leukemia, lymphoma, myelofibrosis, polycythemia vera), thromboembolic disorders, splenic vascular disease, pancreatic disorders, vasculitis, portal hypertension, bacterial endocarditis, sickle cell disease and infiltrative disorders1,3. It is a well-documented complication of lymphoma. However, there are only a few reports of splenic infarction as the initial lymphomas manifestation2,5, with none describing an acute abdomen due to splenic infarct as the initial presentation of diffuse large B-cell lymphoma (DLBCL) to our knowledge.
Herein, is reported a case of a patient who presented with acute abdomen, and was found to have splenic infarction on imaging. Subsequent investigation revealed DLBCL as the etiology of splenic infarction.
The best site for splenic implant was not defined, mainly evaluating the functionality of the implant.
To evaluate the effects of autogenous splenic implantation on the subcutaneous tissue in the survival of splenectomized rats.
Twenty-one randomly assigned rats were studied in three groups (n=7): group 1 - manipulation of the abdominal cavity and preservation of the spleen; group 2 - total splenectomy; group 3 - splenectomy and implant of the tissue removed in the subcutaneous. The animals were followed for 90 days postoperatively.
There was a higher mortality in groups 2 (p=0.0072) and 3 (p=0.0172) in relation to group 1. There was no difference between groups 2 and 3 (p=0.9817).
The splenic implant in the subcutaneous is ineffective in the survival of rats submitted to splenectomy.
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