Splenic injury: management in the Languedoc-Roussillon region.
OBJECTIVE
Treatment of splenic injury is not standardized. We conducted an inventory of splenic injury treatment modalities of splenic injury in the Languedoc-Roussillon region of France.


METHODS
A questionnaire was sent by e-mail to 33 surgeons practicing in 10 hospitals in that region. Surgeons were asked: how many cases were treated per year (PMSI databank for the last three years), local resources (resuscitation bay or intensive care unit, availability of CT and interventional radiology), indications (surgery, embolization, nonoperative management [NOM]), prognostic criteria, NOM modalities (duration of bed rest, hospital stay, restriction of physical activity, thromboembolic prophylaxis, and imaging schedule).


RESULTS
Thirty-one surgeons replied. An average of 185 patients were treated per year. There was consensus concerning the indication for urgent splenectomy, NOM was practiced in the stable patient (even with diffuse hemoperitoneum) and splenic artery embolization was performed for active bleeding (blush on CT) (for the six centers who have interventional radiology at their disposal). Disparities existed between centers concerning the modalities of NOM excepting imaging monitoring, initial surveillance in resuscitation bay or intensive care and in the therapeutic indications when bleeding persisted.


CONCLUSIONS
Based on the consensus observed in this study and an analysis of the literature, a uniform treatment policy can be proposed.
Le Moine
M-C
MC
Service de Chirurgie Digestive et Cancérologie, Centre Hospitalier Carémeau, Place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France. marie.christine.lemoine@chu-nimes.fr
Aguilar
E
E
Vacher
C
C
Passebois
L
L
Bono
D
D
Guillon
F
F
Marchand
J-P
JP
Pirlet
I
I
Forestier
D
D
Rubay
R
R
Toporov
N
N
Carbonel
G
G
Prudhomme
M
M
D032921:Consensus; D003288:Contusions / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D004630:Emergencies; D005602:France; D006452:Hemoglobinometry; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D015642:Radiology, Interventional; D012307:Risk Factors; D013154:Spleen / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries*; D013156:Splenectomy / Q000706:statistics & numerical data*; D013157:Splenic Artery / Q000000981:diagnostic imaging; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data