Modalities in the management of splenic trauma
DOI:
https://doi.org/10.18203/2349-2902.isj20203772Keywords:
Splenic trauma, Conservative management, SplenectomyAbstract
Background: The aim of the study to study the modalities in the management of splenic trauma. Factors affecting non operative management in order to improve the outcome of conservative management, and the factors responsible for conversion to operative management.
Methods: 30 patients were admitted in the Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, satisfying the inclusion criteria between 01 June 2016 to 31 August 2018.
Results: A cross-sectional type of study was performed. Among the 30 patients, 21 were male and 9 were female. It was seen that in 80% of patients the mode of injury was road traffic accident. Human assault, animal attack and fall from height contributed to 6.66% each. The most common reason for conversion to operative management was fragile hemodynamic status of the patient. 20% of the cases were grade I, 40% grade II, 26.66% grade III, 6.66% each of grade IV and grade V, all cases of grade IV and grade V were managed operatively. In this study 60% of the cases could be managed conservatively, 1 case (3.33%) splenorraphy was done. 33.3% (1/3rd) patients required splenectomy, and 1 (3.33%) patient expired who presented late and with hemodynamic instability, belonged to grade V splenic injury.
Conclusions: Conservative management has replaced splenectomy as the most common method of splenic trauma management in patients with stable hemodynamic status. Higher grades of splenic injuries have been managed conservatively. As a result, 60% of all blunt splenic injuries can be managed non-operatively with a success rate of 98%. Operative management associated with stringent intensive care unit (ICU), transfusions are restricted to higher grades of splenic injuries.
References
Institute for Health Metrics: an evaluation. 2020. Available at: http://www.healthdata.org/india. Accessed on 6 May 2020.
2. Kenneth ML, Ernest ME, David FV. Trauma. 7th edition. New York, NY: McGraw-Hill; 2013:561-80.
3. Pachter HL, Guth AA, Hofstetter SR, Spencer FC. Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg. 1998;227:708-17.
4. Sartorelli KH, Frumiento C, Rogers FB, Osler TM. Non-operative management of hepatic, splenic and renal injuries in adults with multiple injuries. J Trauma. 2000;49:56-6.
5. Smith JS, Cooney RN, Mucha P. Non-operative management of the ruptured spleen: a revalidation of criteria. Surg. 1996;120:745-51.
6. Velmahos GC, Zacharias N, Emhoff TA, Feeney JM, Hurst JM, Crookes BA, et al. Management of the most severely injured spleen A: multicenter study of the research consortium of New England Centers for trauma (ReCONECT). Arch Surg. 2010;145(5):456-60.
7. Cathey KL, Brady WJ, Butler K. Blunt splenic trauma: characteristics of patients requiring urgent laparotomy. Am Surg. 1998;65:450-4.
8. Zarzaur BL, Kozar RA, Fabian TC, Coimbra R. A survey of American Association for the surgery of trauma member practices in the management of blunt splenic injury. J Trauma. 2011;70:1026-31.
9. McIntyre LK, Schiff M, Jurkovich GJ. Failure of non-operative management of splenic injuries. Arch Surg. 2005;140:563-9.
10. Pearl RH, Wesson DE, Spence LJ, Filler FM, Ein SH, et al. Splenic injury: a 5 year update with improved results and changing criteria for conservative management. J Pediatr Surg. 1989;24:428-31.
11. Liu PP, Liu HT, Hsieh TM, Huang CY, Fat KS. Nonsurgical management of delayed splenic rupture after blunt trauma. J Trauma Acute Care Surg. 2012;72(4):1019-23.
