Abstract
BackgroundsSplenic injury accounts for 40% of all injuries after blunt abdominal trauma. Blunt splenic injury in hemodynamically unstable patients is preferably treated by splenectomy. Nowadays hemodynamically stable patients with low grade splenic injuries are mostly treated by non-operative management (NOM). However no consensus exists about the management of high grade splenic injuries in hemodynamically stable patients. Therefore the aim of this study was to analyze patients with high grade splenic injuries in our institution.MethodsWe retrospectively included all patients with a splenic injury presented to our level I trauma center during the 5-year period from January 1, 2012, until December 31, 2017. Baseline characteristics, data regarding complications and mortality were collected from the electronic patient registry. Patients were grouped based on splenic injury and the treatment they received.ResultsA total of 123 patients were included, of which 93 (75.6%) were male with a median age of 31 (24–52) and a median injury severity score of 27 (17–34). High grade injuries (n = 28) consisted of 20 Grade IV injuries and 8 grade V injuries. Splenectomy was required in 15/28 (53.6%) patients, of whom all remained hemodynamically unstable after resuscitation, including all grade V injuries. A total of 13 patients with high grade injuries were treated with spleen preserving therapy. Seven of these patients received angio-embolization. One patient went for laparotomy and the spleen was treated with a hemostatic agent. Secondary hemorrhage was present in 3 of these patients (initial treatment: 1 embolization/ 2 observational), resulting in a success rate of 76.9%. There is no mortality seen in patient with high grade splenic injuries.ConclusionNon-operative treatment in high grade splenic injuries is a safe treatment modality in hemodynamically stable patients. Hemodynamic status and peroperative bleeding, not injury severity or splenic injury grade were the drivers for surgical management by splenectomy. This selected cohort of patients must be closely monitored to prevent adverse outcomes from secondary delayed bleeding in case of non-operative management.
Highlights
The spleen in the most frequently injured intraabdominal organ in blunt abdominal trauma [1, 2]
Splenectomy was required in 15/28 (53.6%) patients, of whom all remained hemodynamically unstable after resuscitation, including all grade V injuries
One patient went for laparotomy and the spleen was treated with a hemostatic agent
Summary
The spleen in the most frequently injured intraabdominal organ in blunt abdominal trauma [1, 2]. Until the mid-sixties the only treatment used for blunt splenic injury (BSI) was a splenectomy [3, 4]. In the following years it became more common to preserve the spleen and nowadays the most common approach is nonoperative management (NOM) [5,6,7]. Spleen preservation prevents the patient from the overwhelming post-splenectomy infection (OPSI)syndrome with reported mortality rates up to 70% [9, 10]. Spleen preservation is not always an option since it can lead to life-threatening hemorrhages [11]. The most important prerequisite for successful NOM is adequate patient selection [12,13,14,15]. It is of utmost importance to choose the right management for the right patient
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