Document Type : Research Article
To study various modes of management and to analyze outcomes of different modes of management of splenic trauma.
Material & Methods: This was a retrospective observational study. The study comprised all splenic trauma cases that were brought to our institution and were diagnosed by Focused Abdominal Sonography in Trauma (FAST), CT scan, or per operatively. The study eliminated all abdominal trauma patients without splenic damage as well as seriously injured patients who died while receiving resuscitative care. The NOM was limited to hemodynamically stable patients with grade 1, 2 and 3 splenic injuries and no concomitant intra-abdominal injuries requiring exploratory laparotomy. Others underwent splenectomy and exploratory laparotomies. For a period of two weeks, the NOM patients underwent daily USGs of the abdomen in addition to clinical monitoring. Patients who first had internal bleeding while taking NOM had their spleens removed. Polyvalent pneumococcal vaccination was administered to all Splenectomy patients before discharge. On the eighth postoperative (PO) day, patients who had no issues following surgery were released. Those who experienced issues were released once they had fully recovered.
Results: The most common type of injury is a blunt injury caused by a motor vehicle collision (68.50%). The most prevalent symptoms were abdominal discomfort (86.06%), guarding, rigidity (78.58%), and distension (42.1%). In the NOM group, 85% of patients had uncomplicated hospital stays, 15% experienced problems, and no patients died. In the splenectomy group, 43.6% of patients experienced complications, 52.7% of hospital stays were uneventful, and the death rate was 3.63%. Except for the patient with PTE, all of the patients who passed away during the immediate postoperative period all had serious concomitant injuries and perioperative shock.
Conclusion: NOM can safely treat grade I and grade II splenic injuries without concomitant abdominal injuries requiring laparotomy. Injury severity was highly correlated with outcome.