fibrin and Splenic-Rupture

The aim of the paper was to perform a chronological assessment of the phenomenon of delayed rupture of the spleen, to assess the phenomenological order about the sub-capsular hematoma transformation to determine the causal relationship with trauma as hypothetical cause of death. 80 cases of blunt trauma with splenic capsular hematoma and subsequent rupture of the spleen were evaluated: 38 had an acute rupture of the spleen, 42 presented a break in days or weeks after the traumatic injury. Time between the traumatic event and delayed rupture of the spleen is within a range of time from one day to more than one month. Data recorded included age, sex, type of trauma, injury severity score, grade of splenic injury, associated intra-abdominal injuries, pathologic specimen evaluation. Immunohistochemical investigation of perisplenic hematoma or laceration was performed utilizing polyclonal antibodies anti-fibrinogen, CD61 and CD68, and showed structural chronological differences of sub-capsular hematoma. Expression of modification and organization of erythrocytes, fibrinogen, platelets and macrophages provides an informative picture of the progression of reparative phenomena associated with sub-capsular hematoma and subsequent delayed splenic rupture. Sub-capsular splenic hematoma dating, which we divided into 4 phases, is representing a task in both clinical practice and forensic pathology.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Erythrocytes; Female; Fibrin; Fibrinogen; Forensic Pathology; Hematoma; Hemorrhage; Hemosiderin; Humans; Immunohistochemistry; Lacerations; Macrophages; Male; Middle Aged; Monocytes; Platelet Aggregation; Retrospective Studies; Spleen; Splenic Diseases; Splenic Rupture; Staining and Labeling; Time Factors; Wounds, Nonpenetrating

Topics: Blood Vessel Prosthesis; Bone Transplantation; Bronchial Fistula; Fibrin; Hemorrhage; Splenic Rupture; Surgery, Plastic; Tissue Adhesives

Basing on exemplary case histories - trauma, benign tumour and staging of lymphogranulomatosis - the possibility of maintaining the function of splenic tissue by means of partial splenic resection is discussed. Indication, surgical approach including fibrin glueing and postoperative follow-up are described, taking recent literature into account, and are discussed as an alternative to splenectomy and autotransplantation.

Topics: Child; Fibrin; Hodgkin Disease; Humans; Male; Neoplasm Staging; Splenectomy; Splenic Neoplasms; Splenic Rupture; Tissue Adhesives

Over a period of 14 months, 2 traumatic and 14 intraoperative splenic lesions were managed by application of fibrin tissue adhesive, mostly in combination with the use of a collagen sponge. In all cases hemorrhage could be stopped completely with out mobilization of the spleen. This method proved to be very suitable in the repair of smaller incidental capsular tears. In the management of more extensive traumatic ruptures, it should support the conventional surgical techniques described in the literature. It certainly will make these procedures safer and easier to perform.

Topics: Adolescent; Adult; Aged; Female; Fibrin; Fibrinogen; Hemostasis; Humans; Intraoperative Complications; Male; Middle Aged; Spleen; Splenic Rupture; Tissue Adhesives; Wound Healing