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Laparoscopic splenectomy in a case of blunt abdominal trauma.

Agarwal N - J Minim Access Surg (2009 Jul-Sep)

Bottom Line: Laparoscopic splenectomy was first described in 1991 by Delaitre and Maignien.Since then significant improvements in instrumentation and technology such as harmonic scalpel, endovascular staplers have increased its ease of performance.We present the first reported case from India (to the best of our knowledge) of a successful removal of a ruptured spleen by means of a totally laparoscopic technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Apollo Hospital, Sarita Vihar, New Delhi, India.

ABSTRACT
Splenic rupture is a frequent consequence of blunt abdominal trauma. Removal of the spleen (splenectomy) or alternative conservative procedures (splenorrhaphy, partial splenectomy and haemostatic collagen application) are surgical treatment options. Splenectomy was first described in 1910 by Sutherland. Laparoscopic splenectomy was first described in 1991 by Delaitre and Maignien. Since then significant improvements in instrumentation and technology such as harmonic scalpel, endovascular staplers have increased its ease of performance. Laparoscopic splenectomy for a ruptured spleen has been reported only in a few cases, in which a hand-assisted technique was used. We present the first reported case from India (to the best of our knowledge) of a successful removal of a ruptured spleen by means of a totally laparoscopic technique.

No MeSH data available.


Related in: MedlinePlus

Pre-operative CT scan showing splenic injury and collection
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Figure 0001: Pre-operative CT scan showing splenic injury and collection

Mentions: A 46-year-old man was admitted to our hospital on an emergent basis after a motor vehicle trauma. His only complaint was of pain over the left flank. He did not have any peritoneal signs, and examination was unremarkable except for left flank tenderness. X-rays revealed fractures of left eighth and ninth ribs. Plain CT scan of thorax and abdomen confirmed the radiographic findings with evidence of splenic injury (Grade II and Grade III) with mild perisplenic collection [Figure 1]. On admission, he had an Hb of 14.1 g/dl. The patient was nursed in HDU and the CECT repeated on the next day revealed an increase in the size of splenic and perisplenic collection. The patient had a stable blood pressure but progressive tachycardia was noted. Subsequent blood pictures showed a decreasing trend of haemoglobin to 12.9 gm/dl and then to 11.8 gm/ dl. The various management options were discussed with the patient, including observation, angiographic embolization and splenectomy. We decided to proceed with diagnostic laparoscopy and splenectomy.


Laparoscopic splenectomy in a case of blunt abdominal trauma.

Agarwal N - J Minim Access Surg (2009 Jul-Sep)

Pre-operative CT scan showing splenic injury and collection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822176&req=5

Figure 0001: Pre-operative CT scan showing splenic injury and collection
Mentions: A 46-year-old man was admitted to our hospital on an emergent basis after a motor vehicle trauma. His only complaint was of pain over the left flank. He did not have any peritoneal signs, and examination was unremarkable except for left flank tenderness. X-rays revealed fractures of left eighth and ninth ribs. Plain CT scan of thorax and abdomen confirmed the radiographic findings with evidence of splenic injury (Grade II and Grade III) with mild perisplenic collection [Figure 1]. On admission, he had an Hb of 14.1 g/dl. The patient was nursed in HDU and the CECT repeated on the next day revealed an increase in the size of splenic and perisplenic collection. The patient had a stable blood pressure but progressive tachycardia was noted. Subsequent blood pictures showed a decreasing trend of haemoglobin to 12.9 gm/dl and then to 11.8 gm/ dl. The various management options were discussed with the patient, including observation, angiographic embolization and splenectomy. We decided to proceed with diagnostic laparoscopy and splenectomy.

Bottom Line: Laparoscopic splenectomy was first described in 1991 by Delaitre and Maignien.Since then significant improvements in instrumentation and technology such as harmonic scalpel, endovascular staplers have increased its ease of performance.We present the first reported case from India (to the best of our knowledge) of a successful removal of a ruptured spleen by means of a totally laparoscopic technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Apollo Hospital, Sarita Vihar, New Delhi, India.

ABSTRACT
Splenic rupture is a frequent consequence of blunt abdominal trauma. Removal of the spleen (splenectomy) or alternative conservative procedures (splenorrhaphy, partial splenectomy and haemostatic collagen application) are surgical treatment options. Splenectomy was first described in 1910 by Sutherland. Laparoscopic splenectomy was first described in 1991 by Delaitre and Maignien. Since then significant improvements in instrumentation and technology such as harmonic scalpel, endovascular staplers have increased its ease of performance. Laparoscopic splenectomy for a ruptured spleen has been reported only in a few cases, in which a hand-assisted technique was used. We present the first reported case from India (to the best of our knowledge) of a successful removal of a ruptured spleen by means of a totally laparoscopic technique.

No MeSH data available.


Related in: MedlinePlus