Role of Computed Tomography Scan in the Assessment and Management of Blunt Splenic Trauma in a Tertiary Care Hospital, Assam, India

Abstract

Introduction: Trauma is the most common cause of mortality and morbidity in young individuals. Penetrating splenic injuries are more common than blunt injuries. The management of blunt splenic trauma has substantially evolved over the last few decades, moving from routine splenectomy to preserving the spleen wherever feasible. Aim: To determine the role of Multidetector Computed Tomography (MDCT) in the diagnosis and treatment of blunt splenic trauma. Materials and Methods: This hospital-based retrospective study was conducted in Department of General Surgery, Tezpur Medical College and Hospital, Tezpur, Assam, India. During the study period, there were 132 cases of blunt trauma abdomen. Among them, 122 patients had undergone MDCT of the abdomen. Clinical details of those 122 patients who did MDCT for possible blunt trauma of the abdomen were traced and were admitted to the Department of General Surgery, Tezpur Medical College and Hospital, Tezpur, Assam, India during the period from 1st October 2021 to 31st August 2022 retrospectively. The clinical data of these 122 patients were recorded. Of these 122 patients who underwent MDCT, 21 had splenic injuries. The patients who were treated conservatively were traced and the outcome of the treatment on follow-up, from the clinical notes. The preliminary MDCT findings of the patients were correlated with the final diagnosis and treatment. Fisher’s-exact tests and Chi-square were used for statistical analysis. Results: The 21 splenic injuries in this study were classified based on the American Association for the Surgery of Trauma (AAST) grading scales for organ injury, and 14 (66.67%) had Non Operative Management (NOM). Of the four patients with Contrast Material Extravasation (CME), all of them had undergone laparotomy related to the spleen (100%) and demonstrated active bleeding during surgery, but only three of the remaining 17 patients without CME (17.65%) required laparotomy related to the spleen; the difference was statistically found to be significant (p<0.01). Conclusion: The accurate diagnosis provided by MDCT evaluation of blunt splenic injuries helps in formulating the right approach for better management.