Splenic Trauma: Try to save the Spleen in Stable Patients

Abstract

Introduction: The treatment of blunt splenic injuries has changed significantly during the last 30 years with the non-operative management (NOM) because it allows preservation of the immune functions of the spleen and avoid complication of splenectomie. The aim of this paper is to study the epidemiological, clinical and paraclinical profile, and to undreline the place of the conservative treatment in the management of the splenic trauma. Methods: Our work concerned 37 patients victims of splenic trauma, listed in the visceral surgery service, over a period from January, 2013 till December, 2020. The average age of our patients was 33.4 years with a sex-ratio of 3.1. Étiologies was dominated by the road traffic accident 17 (45.9%), followed by falls 9 (24.3%), then by attacks 8 (21.6%) by cutting weapon. The multi trauma context was the most frequent in (95 %). 15 patients were unstable on the hémodynamic shot (40.5%). Ultrasonography was realized at 17 patients (46%) and it showed abdominal effusion in 15 cases (44.1%), CT scan was realized at 32 patients and has showed 19 cases of splénic contusion among which 8 patients were in grade V. 18 patients were operated in emergency (48.6%) (17 cases of hémodynamic instability and 1 with pancreatic trauma). The nonoperative treatment was adopted for 19 patients (51.3 %). The evolution was good at 29 patients (78.4 %). Conclusion: NOM of patients with spleen injury could be an alternative therapeutic even in case of severe lesions.