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 JOURNAL READ

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7/25/2019 Journal Reading Trauma Tumpul Limpa

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ABSTRAT Since the 1970s, the management of blu

trauma has evolved from almost exclusivmanagement to selective use of nmanagement in hemodynamically stableUnderstanding of the spleen’s imimportance in protection against ovepostsplenectomy infection led to developm

surgical techni"ues for splenic salvage anprotocols for nonsurgical management of ablunt splenic in#ury. $he evolution of nmanagement has resulted in ne papostsplenic trauma complications.

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 $his article describes a splenic pseudocyseveral described delayed complicanonsurgical management of blunt splen%long ith missed splenic in#ury and delayethe development of a splenic pseudocyst

challenges for any multidisciplinary team itrauma care. &etection and managemencomplications is discussed, as is postspvaccination and return to activity.

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ASE PRESENTATION % man, age 19 years, presented to

his 'rimary (are physician ith left

upper "uadrant pain. )ne monthearlier, he had been found to haveinfectious mononucleosis.

)utpatient abdominalultrasonography revealed

splenomegaly ith contourirregularity of the spleen.(omputed tomography *($+demonstrated a very large splenicpseudocyst *ig 1+. -e as referredto general surgery for further

treatment.

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DISUSSION

T!i" #a"$ r$pr$"$nt" on$ o% ($'a)$( #o*p'i#ation" o% b'unt injur) $n#ount$r$( b) our +$n$ra't$a*. A'on+ it! *i""$( "p'$nian( ($'a)$( ruptur$, t!$ ($&$'opa "p'$ni# p"$u(o#)"t r$#!a''$n+$" %or an) *u'ti(i"#ip'inain&o'&$( in trau*a #ar$.

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A%t$r #on"u'tation it! an att$n(in+"ur+$on at a 'o#a' trau*a #$nt$r, p'*a($ %or Int$r&$ntiona' Ra(io'o+) tot!$ p"$u(o#)"t. A #'ini#ian $a"i') r$*o*L o% o'( b'oo(, an( on') a "*a'' r$"i

#o''$#tion r$*ain$( a%t$r t!$ pro#$(*ont! 'at$r, %o''o1up T ($*r$a##u*u'ation o% t!$ 0ui(. T!i" in($''in+ (rain a" p'a#$( b) Int$rRa(io'o+). O&$r t!$ n$2t *ont!, #o''$#tion r$"o'&$( an( t!$ (rain a"

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On$ *ont! 'at$r, t!$ pati$nt in#r$a"in+ '$%t upp$r 3ua(rant pain. R($*on"trat$( r$#urr$n#$ o% t!$ 0ui( #It a" a+ain p$r#utan$ou"') (rain$(, au+*$nt$( b) t!$ u"$ o% ti""u$ p'a

a#ti&ator a(*ini"t$r$( t!rou+! t!Anot!$r *ont! pa""$(, t!$ 0ui( r$"o'&$(, an( t!$ "p'$$n app$ar$( nT. T!$ (rain a" r$*o&$(.

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MISSED SPLENI INJUR4 

Mi""$( "p'$ni# injur) i" t!$ *o"t #o**opr$&$ntab'$ ($at! a%t$r b'unt ab(o*inao*par$( it! pati$nt" in !o* injur) i"r$#o+ni5$(, t!o"$ it! ($'a) in (ia+no"i"trau*a !a&$ a t$n1%o'( in#r$a"$ in *ortt!$r$%or$ i*portant to !a&$ a !i+!

"u"pi#ion %or t!i" (ia+no"i" !$n $pati$nt" it! b'unt trau*a. T!$ *o"t6n(in+ a""o#iat$( it! "p'$ni# ruptur$ i"rib %ra#tur$", !i#! o##ur in 78/9 o% #a"$

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DELA4ED RUPTURE OF T:ESPLEEN

T!$ in#i($n#$ i" appro2i*at$') -9, anto o##ur b$t$$n 8 an( ; (a)" a%tMorta'it) ran+$" %ro* 9 to -9, #it! -9 *orta'it) %or a#ut$ injur).

Pro*pt r$#o+nition o% t!$ "i+n" an( "

o% ($'a)$( "p'$ni# ruptur$ i" $""$ntia't)pi#a'') $2!ibit !)pot$n"ion, ta#or"$nin+ ab(o*ina' pain an( (i"t$n"i($#r$a"in+ !$*ato#rit.

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SPLENI PSEUDO4ST

T!$ (ia+no"i" o% "p'$ni# p"$u(o#)"t i"

*or$ #o**on, probab') b$#au"$ in#r$a"in+ u"$ o% T an( u'tra"ono+$&a'uat$ #o*p'aint" o% upp$r ab(o*in$'' a" t!$ in#r$a"$( %r$3u$n#) o% nontr$at*$nt o% b'unt "p'$ni# trau*a.

</9 to =/9 o% "p'$ni# p"$u(o#a")*pto*ati#, #au"in+ prob'$*" on')$n'ar+$. o**on pr$"$ntin+ #o*p'aint'$%t upp$r 3ua(rant pain an( nau&o*itin+ b$#au"$ o% #o*pr$""ion "to*a#!. Dia+no"i" i" *a($ in t!$ "$t!i"tor) o% b'unt ab(o*ina' trau*ab(o*ina' pain, an( a p$ri"p'$ni#

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O>ER?:ELMINGPOSTSPLENETOM4 INFET

OPSI, t)pi#a'') #au"$( b) t!$ $n#aor+ani"*" Str$pto#o##u" pn:a$*op!i'u" in0u$n5a, an( *$nin+iti(i", o##ur" in /./9 to @9 o%!o !a&$ un($r+on$ "p'$n$#to*). Mo

"i+ni6#ant an( a" !i+! a" /9. A%t$r "p'$n$#to*), r$(u#$( '$&$'"

op"onin", an( "p'$ni# tu%t"in !a*p$r tabi'it) to #'$ar $n#ap"u'at$( ba#t$ria.

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RETURN TO ATI>IT4 

Anot!$r ar$a o% #ontro&$r") in t!$ tr$apati$nt" a%t$r "p'$ni# trau*a i" ti*in+to a#ti&it). Tra(itiona''), pati$nt" !a&$ to r$%rain %ro* p!)"i#a' a#ti&it) %*ont!" a%t$r "p'$ni# injur).

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ONLUSION

D$'a)$( #o*p'i#ation" o% b'unt trau*a *a) b$ $n#ount$r$( in out"i($ o% trau*a #$nt$r". Pra#t*u"t b$ %a*i'iar it! t!$"$ i""in&o'&$ appropriat$ "p$#ia'i"t" a"in t!$ #ar$ o% pati$nt" it! "p'$ni

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TERIMA