Abstract
Background
Non-operative management (NOM) of blunt splenic or liver injuries (solid organ injury, SOI) has become the standard of care in hemodynamically stable patients. However, the incidence of long-term symptoms in these patients is currently not known. The aim of this study was to assess long-term symptoms in patients undergoing successful NOM (sNOM) for SOI.
Methods
Long-term posttraumatic outcomes including chronic abdominal pain, irregular bowel movements, and recurrent infections were assessed using a specifically designed questionnaire and analyzed by univariable analysis.
Results
Eighty out of 138 (58%) patients with SOI undergoing sNOM) responded to the questionnaire. Median (IQR) follow-up time was 48.8 (28) months. Twenty-seven (34%) patients complained of at least one of the following symptoms: 17 (53%) chronic abdominal pain, 13 (41%) irregular bowel movements, and 8 (25%) recurrent infections. One female patient reported secondary infertility. No significant association between the above-mentioned symptoms and the Injury Severity Score, amount of hemoperitoneum, or high-grade SOI was found. Patients with chronic pain were significantly younger than asymptomatic patients (32.1 ± 14.5 vs. 48.3 ± 19.4 years, p = 0.002). Irregular bowel movements were significantly more frequent in patients with severe pelvic fractures (15.4 vs. 0.0%, p = 0.025). A trend toward a higher frequency of recurrent infections was found in patients with splenic injuries (15.9 vs. 2.8%, p = 0.067).
Conclusion
A third of patients with blunt SOI undergoing sNOM reported long-term abdominal symptoms. Younger age was associated with chronic abdominal symptoms. More studies are warranted to investigate long-term outcomes immunologic sequelae in patients after sNOM for SOI.
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References
Zago TM, Pereira BM, Calderan TR, Hirano ES, Rizoli S, Fraga GP (2012) Blunt hepatic trauma: comparison between surgical and nonoperative treatment. Revista do Colegio Brasileiro de Cirurgioes 39:307–313
Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP (2013) Non operative management of abdominal trauma—a 10 years review. World J Emerg Surg WJES 8:14
Schnuriger B, Martens F, Eberle BM, Renzulli P, Seiler CA (2013) Candinas D [Treatment practice in patients with isolated blunt splenic injuries. A survey of Swiss traumatologists]. Der Unfallchirurg 116:47–52
Olthof DC, van der Vlies CH, Goslings JC (2017) Evidence-based management and controversies in blunt splenic trauma. Curr Trauma Rep 3:32–37
Schnuriger B, Inderbitzin D, Schafer M, Kickuth R, Exadaktylos A, Candinas D (2009) Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma. Br J Surg 96:104–110
Renzulli P, Gross T, Schnuriger B et al (2010) Management of blunt injuries to the spleen. Br J Surg 97:1696–1703
Peitzman AB, Heil B, Rivera L et al (2000) Blunt splenic injury in adults: multi-institutional study of the eastern association for the surgery of trauma. J Trauma 49:177–187 (discussion 87–89)
Freitas G, Olufajo OA, Hammouda K et al (2016) Postdischarge complications following nonoperative management of blunt splenic injury. Am J Surg 211(744–9):e1
Wernick B, Cipriano A, Odom SR et al (2017) Temporal changes in hematologic markers after splenectomy, splenic embolization, and observation for trauma. Eur J Trauma Emerg Surg 43:399–409
Skattum J, Titze TL, Dormagen JB et al (2012) Preserved splenic function after angioembolisation of high grade injury. Injury 43:62–66
Skattum J, Loekke RJ, Titze TL et al (2014) Preserved function after angioembolisation of splenic injury in children and adolescents: a case control study. Injury 45:156–159
Olufajo OA, Rios-Diaz A, Peetz AB et al (2016) Comparing readmissions and infectious complications of blunt splenic injuries using a statewide database. Surg Infect 17:191–197
Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 38:323–324
Ahmed W, Alwe R, Wade D (2017) One-year functional outcomes following major trauma: experience of a UK level 1 major trauma centre. Clin Rehabil. https://doi.org/10.1177/0269215517712044
Chin WS, Shiao JS, Liao SC, Kuo CY, Chen CC, Guo YL (2017) Depressive, anxiety and post-traumatic stress disorders at six years after occupational injuries. Eur Arch Psychiatry Clin Neurosci 267:507–516
Palm S, Ronnback L, Johansson B (2017) Long-term mental fatigue after traumatic brain injury and impact on employment status. J Rehabil Med 49:228–233
Menzies D, Ellis H (1990) Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl 72:60–63
Schnuriger B, Barmparas G, Branco BC, Lustenberger T, Inaba K, Demetriades D (2011) Prevention of postoperative peritoneal adhesions: a review of the literature. Am J Surg 201:111–121
Weibel MA, Majno G (1973) Peritoneal adhesions and their relation to abdominal surgery. A postmortem study. Am J Surg 126:345–353
Aiolfi A, Inaba K, Strumwasser A et al (2017) Splenic artery embolization versus splenectomy: analysis for early in-hospital infectious complications and outcomes. J Trauma Acute Care Surg 83:356–360
Demetriades D, Scalea TM, Degiannis E et al (2012) Blunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study. J Trauma Acute Care Surg 72:229–234
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Peter Moreno, Matthias Von Allmen, Tobias Haltmeier, Daniel Candinas, and Beat Schnüriger have no conflicts of interest or financial ties to disclose.
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Moreno, P., Von Allmen, M., Haltmeier, T. et al. Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey. World J Surg 42, 1358–1363 (2018). https://doi.org/10.1007/s00268-017-4336-5
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DOI: https://doi.org/10.1007/s00268-017-4336-5