Endovascular treatment of active splenic bleeding after colonoscopy: a systematic review of the literature.

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Serval ID
serval:BIB_CF0D2600FFFE
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Endovascular treatment of active splenic bleeding after colonoscopy: a systematic review of the literature.
Journal
Cardiovascular and Interventional Radiology
Author(s)
Corcillo A., Aellen S., Zingg T., Bize P., Demartines N., Denys A.
ISSN
1432-086X (Electronic)
ISSN-L
0174-1551
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
36
Number
5
Pages
1270-1279
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish
Abstract
PURPOSE: Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures.
METHODS: We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reported case of PSAE) was performed and the three types of treatment compared.
RESULTS: All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST.
CONCLUSION: We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic ruptures after colonoscopy in hemodynamically stabilized patients.
Pubmed
Web of science
Open Access
Yes
Create date
06/02/2013 11:56
Last modification date
01/10/2019 7:19
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