腹腔镜脾切除术失败NOM+ AE操作

                               
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Laparoscopic splenectomy for blunt abdominal trauma and splenic injury grade III AAST in a 30 years old patient with splenomegaly and mild portal hypertension. The patient had an MVA-Pedestrian accident and underwent initial NOM + AE for proximal SAE (aiming to reduce the flow rate and decrease the risks of NOM failure). In the following 36 hours Hb levels dropped gradually and continuously despite blood transfusion. The patient remained hemodynamically stable. Laparoscopic splenectomy was performed. During splenic hilum stapling, a sudden copious venous bleeding occurred from the splenic hilum (31min15sec) and it was controlled by immediate selective clamping with Atraumatic graspers and proximal endo-stapling. Postoperative outcomes are shown.

Operating Surgeon: Dr. Salomone Di Saverio MD, FACS, FRCS
Assisting Resident Surgeon: Dr. Mario Chisari
Maggiore Hospital Trauma Center, Trauma Surgery Unit (Head Dr. Gregorio Tugnoli)
AUSL Bologna, Italy