Organ–preserving operations for the gun–shot thoraco–abdominal and abdominal woundings with splenic injuries

Abstract

Objective.To determine the expediency of the spleen–preserving operations performance for its injury due to gun–shot thoraco–abdominal and abdominal woundings.
 Materials and methods. Of 51wounded persons with the gun–shot penetrating abdominal woundings with splenic injuries 8 (15.7%) were operated on the II level of the medical help delivery, while on the ІІІ level – 43 (84.3%). Of 43 wounded persons, operated on the ІІІ level of the medical help delivery, in 35 (81.4%) splenectomy was performed, while in 8 (18.6%) – the organ–preserving operations. All the splenic injuries have been characterized as a shrapnel woundings. The splenic damage degree was estimated in accordance to Moore, taking into account its structure. In 5 (62.5%) wounded persons the open laparotomy organ–preserving operations were performed, and while using video–laparoscopic system– in 3 (37.5%).
 Results. Ultrasonographic investigation in accordance to the FAST–protocol was done in all the wounded persons, what have permitted to determine the blood abdominal outpouring volume as well as the splenic injury presence. The affection volume and further tactics were determined using video–laparoscopy. The Stage I splenic affection in accordance to Moore was diagnosed in 4 (50%) wounded persons, the Stage ІІ – in 3 (37.5%), and the Stage ІІІ – in 1 (12.5%). In all the patients, in whom organ–preserving interventions were performed, the surgical help volume consisted of coagulation, using the radiofrequency therapy apparatus MEDTRONICAEX and the hemostatic sponge application with drainage of the left subdiaphragmatic space, using silicone tube.
 Conclusion. Organ–preserving operations in splenic injury are expedient to be performed on ІІІ level of the medical help delivery, while presence of local conditions, such as the organ injury degrees І and ІІ,determined in accordance to Moore, as well as adequate time and equipment.