ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 34 of 44
УЖМБС 2019, 4(2): 226–235
Forensic Medicine

Dynamics of Ultrasound and Histological Changes in Determining the Rate of Spleen Damage injured in the Absence of Alcohol Intoxication

Babkina O. P. 1, Matiukhin D. O. 2, Zolotarevskiy R. S. 3, Danylchenko S. I. 4

The article presents data from literary sources and the statistical analysis on the nature, mechanisms and prescription of spleen injury in case of mechanical trauma and the absence of alcohol intoxication in order to improve the diagnosis, treatment and prevention of spleen injuries. According to the literature the frequency of spleen injuries ranges from 15 to 33%. Ultrasound and histological methods are usually used in the long-term follow-up of spleen injuries. The purpose of the work was to study the dynamic changes of ultrasound indexes and histological parameters of injured spleen tissues in various types of mechanical injury, depending on the period of injury. Material and methods. We studied the spleen tissues of 56 people aged from 20 to 60, with known and unknown time of injury, and death occurrence both with and without alcohol intoxication. These people underwent an autopsy in the anatomical department of the Forensic Medical Examination Bureau. In the conducted research we used histological and histochemical techniques to detect dynamic processes of regeneration, and histological parameters of the injured spleen tissues. We also performed statistical analysis of the results. To detect pathological changes in organs and tissues we used ultrasound with frequency from 0.5 to 1.5 million vehicles fluctuations on Sonoace 8000 (South Korea), Sonosite Titan (USA). The abdomen and retroperitoneal area examination was conducted while registering 51 injured people to hospitals, as well as in the dynamics of 1, 2, 3 and 5 days after injury. Results and discussion. The obtained results showed that the mechanical injury of spleen ruptures often developed capsule and parenchyma with a hemorrhage in the area of injury. During the first 6 hours after injury histological examination of the spleen showed orange hematoma in a cluster of erythrocytes with clear contours, central pieces of hematoma had hemolysis of erythrocytes. Closer to the edges of hematoma we observed single leukocytes, and fibrin strands. We also noted that perifocal edema increased by the contours of hematoma. Lekocytic stasis and perifocal accumulation of leukocytes were observed in vessels. Nearby vessels, sinuses, sometimes in the damaged areas showed small clusters of leukocytes not associated with blood vessels. 6-12 hours after injury most red blood cells in the center of injury had vague outlines, some intact erythrocytes were just on the edges of hematoma, the number of granulocytes in hematoma increased and began their destruction. The periphery of hematoma continued accumulation of decaying granulocytes, there appeared strands of fibrin to form clusters for the torus demarcationis which clearly marked areas of damaged parenchyma intact. The sinuses perifocal zone showed focal accumulation of granulocytes. We observed hemolyzed erythrocytes and completely destroyed granulocytes 12-24 hours after the injury. The torus demarcationis was represented with destroyed granulocytes, macrophages with hemosiderin intracellular grains, fibrin strands on the edge of the hematoma intact tissues. Blood clots were detected in the blood vessels. Further, after 2-3 days, there began resorption of erythrocyte destruction products and formation of siderophages. The proliferation of histio-fibroblastic cells and platelets organization in the vessels (the appearance of fibroblasts and blood clots in the blood vessels) started on the border of hematoma with intact tissue. The formation of torus demarcationis continued in the form of fuzzy mass of fibrin strands which form delicate collagen fibers including many hemosiderophages. Perifocal proliferative and leukocyte reactions were reduced and hardly expressed. Sometimes there was extracellularly located pale yellow hemosiderin. Within 4-6 days of injury prescription we observed prevalence of connective tissue elements (lymphocytes, histiocytes, plasma cells), and massive collapse of granulocytes, signs of blood clots in the spleen vessels. 6 days after injury capsules of hematoma were still formed. Hematoma was presented with completely hemolyzed erythrocytes, a large number of leukocytes nuclear detritus with broken integrity, compacted fibrin strands clearly demarcating hematoma of damaged tissue, and delicate collagen fibers beginning to form a capsule. Multiple strands of histofibroblastic cellular elements grew from parenchymal hematoma. They were located both in sorted and chaotic order. According to our data, when establishing this type of injury, the well-assembled medical record, knowledge of the mechanism of injury, laboratory blood and urine tests help with the maintenance of the abdominal cavity and retroperitoneum laparoscopy, and ultrasound of the internal organs of the abdominal cavity. Clinical and ultrasound diagnosis of spleen injury is quite complicated in all cases of mechanical injury. Isolated spleen injury was observed in 18 patients (33%), and in 33 patients (65%) spleen injury was combined with liver damage, gall bladder and extrahepatic bile duct, pancreatic, intestine. Ultrasound examination was complicated by intestinal hyperpneumatosis in the development of dynamic bowel obstruction and diffuses peritonitis. Conclusions. The obtained results showed that ultrasound parameters and morphological picture could differ from those explained earlier that you must consider when establishing the prescription of injury. Using ultrasound and histological methods to determine the injury prescription, as in the case of isolated spleen injury, and in the case of multiple abdomen trauma, is appropriate because it allows you to establish limitations causing injury more precisely.

Keywords: forensic medical examination, trauma, prescription, spleen, histological parameters, ultrasound parameters, alcohol intoxication

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