[Conservative management of splenic lesions: experience in 136 patients with blunt splenic injury].
OBJECTIVE
To evaluate the usefulness of imaging tests in selecting the treatment for patients with blunt splenic trauma. To relate the grade of splenic lesion with the treatment. To describe the benefits of embolization in splenic trauma.


METHODS
We retrospectively studied 136 splenic lesions. We analyzed the main mechanisms of injury, the imaging findings at focused assessment with sonography for trauma (FAST US) and CT, the spectrum of lesions, the therapeutic management, and the outcome.


RESULTS
The mean age of patients was 34.81 years and the most common mechanism of injury was traffic accidents. Signs of hemodynamic instability were observed in 54 (39.70%) patients; the remaining 82 (60.30%) patients remained stable or responded to resuscitation. FAST US was the initial imaging technique and the most commonly used technique in unstable patients, whereas CT was the most commonly used technique in stable patients. Surgical treatment was used in 79.99% of the high grade lesions and conservative treatment was used in 55.69% of the low grade lesions. Angiography and embolization were used to manage 8.54% of the stable patients.


CONCLUSIONS
FAST US is decisive in choosing the surgical treatment in unstable patients. High grade lesions are associated with a higher frequency of surgery and lower grade lesions are associated with a higher frequency of nonsurgical management. Angiography with embolization is efficacious in the treatment of vascular lesions in stable patients.
Hilario Barrio
A
A
Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain. amayahilario@yahoo.es
Borruel Nacenta
S
S
Plá Romero
A
A
Sánchez Guerrero
A
A
García Fuentes
C
C
Chico Fernández
M
M
Roldán Ramos
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult