CLINICAL STUDY ON CONSERVATIVE MANAGEMENT OF BLUNT SPLENIC INJURY

Abstract

Background: Spleen is the most common intra-abdominal organ to be injured in blunt abdominal trauma and currently most cases are treated nonoperatively. Aim of this study was to evaluate the efcacy of Non-Operative Management (NOM) of blunt splenic injury and to point out the predictors of failure of NOM. Methods: Over a 12 month period (June 2021- May 2022), 16 hemodynamically stable patients with blunt splenic injury admitted in Department of General Surgery in Silchar Medical College and Hospital were evaluated prospectively. Association of various factors were analysed using SPSS statistical software version 22 to nd out efcacy of NOM as well as to point out predictors of NOM. Results: NOM was successful in 81.3% of patients and 18.8% were converted to operative management (NOM failure). Statistical analysis showed that Systolic BP and Haemoglobin at the time of admission, Number of blood transfused, Injury Severity Score (ISS), USG nding of grade of hemoperitoneum, American Association for Surgery of Trauma (AAST) grade of splenic injury, Duration of hospital stay were signicantly associated with the outcome of NOM success (P value < 0.05). Age, Sex, Mode of injury, Pulse rate at the time of admission had no signicant relation with the outcome. AASTgrade IV splenic injury or higher, Massive hemoperitoneum, ISS > 25, Haemoglobin <8 gm%, Requirement of 4 or more units of blood and New-onset hemodynamic instability were independent predictors of failure of conservative management. Conclusion: Conservative management of blunt splenic injury is safe and effective as long as patients are selected based on strict inclusion/exclusion criteria