Iatrogenic splenic injury

Article Abstract:

Iatrogenic injury is damage to the body caused by a physician or surgeon. During abdominal operations, such injuries can occur to the spleen, particularly when procedures are performed on the stomach, kidney, or aorta (the large artery carrying blood to the lower part of the body). Although surgeons are well aware of the possibility of this complication, the issue has not been recently assessed. To this end, a review was conducted of the records of 1,557 splenectomies (removal of the spleen) performed between 1971 and 1987. Of these, 9 percent (134) had been performed due to iatrogenic injury to the spleen; in the other 91 percent, the spleen was removed for other reasons. A partial breakdown of the operations during which the spleen was inadvertently damaged was: gastric procedures, 32 patients; nephrectomy (removal of a kidney), 28 patients; colectomy (removal of the colon), 24 patients; repair of hiatus hernia (protrusion of part of the stomach above the diaphragm), 14 patients; and resection of an aortic aneurysm (removal of a dilated part of the aortic wall), 11 patients. In many patients, extensive cancer in the region where the surgeon worked was associated with iatrogenic injury. Thirteen patients for whom splenic trauma was not noted during the original surgical procedure required re-operation to control bleeding. The consequences of damage to the spleen have been a subject of intense debate for decades; a review of relevant articles is provided. The complications are certainly more serious if damage to the spleen goes unrecognized and internal bleeding is allowed to continue. The importance of proper preventive and corrective measures is emphasized. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Causes of, Complications and side effects, Surgery, Postoperative complications, Abdomen, Laparotomy, Splenectomy, Surgical errors

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Trend toward nonoperative management of splenic injuries

Article Abstract:

Over the past 10 years there has been a change in the methods of treatment of the injured spleen, the highly vascular organ located between the stomach and diaphragm considered part of the lymphatic system, which plays a role in the body's defense mechanism. Because of the significant risk of sepsis (poisoning of the system by infection) following removal of the spleen, alternative treatment may be used. For children, non-operative treatment of splenic injury has become standard. There is controversy regarding nonoperative treatment of the adult patient. A study was undertaken to evaluate methods of spleen-saving treatments. Records of 169 patients with splenic injuries were reviewed, consisting of 143 adults and 26 children (less than 17 years of age). The average age in the adult group was 31.6 years, and in the pediatric group 11.4 years; 72 percent of the overall group were males. There were 66 patients treated from 1983 through 1985, and 103 treated from 1986 through 1988. Non-operative treatment was used in 8 percent of the adult group and 23 percent of the pediatric group. Splenectomy (spleen removal) was performed in 48 percent of the adult group, and in 31 percent of the pediatric group. In the more recent group, nonoperative treatment was used more frequently than in the group treated earlier; 15 percent, compared with 2 percent. The rate of splenectomy decreased from 59 percent to 38 percent. The spleen was salvaged in 41 percent of the early group, compared with 61 percent in the later group. No increase in morbidity or mortality accompanied nonoperative treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Wounds and injuries, Wound care, Blunt trauma

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Effect of major trauma on plasma free amino acid concentrations in geriatric patients

Article Abstract:

Aging is associated with a variety of metabolic changes, including loss of protein from muscles. The rate of protein synthesis decreases, and this may be related to the availability of amino acids, which are the building blocks of which proteins are made. Elderly people recover less easily from major trauma, and this loss in capacity to respond to injury may be related to disturbed protein metabolism. The relationship between availability of amino acids in the blood stream and the early metabolic reactions to major trauma in 9 geriatric (aged 61 to 81) and 13 young (aged 20 to 38) patients was studied. These trauma patients were also compared with healthy controls; eight controls were elderly and 10 were young. Older controls had reduced levels of total amino acids and of certain specific amino acids. Such declines were less obvious in traumatized elderly patients because they were compared with young trauma patients, who experienced even greater declines in certain amino acid levels in response to trauma. Geriatric patients had specific declines of the amino acids arginine and methionine, while ornithine and citrulline increased. The results suggest that geriatric trauma patients would be aided by balanced amino acid supplementation, which would enable optimum synthesis of new proteins by the body in response to trauma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Aged, Elderly, Physiological aspects, Nutritional aspects, Amino acids, Proteins in human nutrition, Dietary protein, Traumatology

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