Abstract
Background: Spleen injuries are most commonly associated with blunt abdominal trauma and represent a potentially life-threatening condition. Objectives: To study the pattern of splenic injuries of the patient, management instituted and its outcome at Khartoum. Patients and Methods: This is a prospective, analytic and hospital-based multicenteric study, conducted at the three main Teaching hospitals at Khartoum. The study was carried over a period from April 2012 to February 2013. It includes all patients, diagnosed as traumatic splenic injury. Excluded were patients with history of splenic disease, iatrogenic injury or spontaneous rupture. Results: The study included 47 patients: their mean age was 26.4 years (SD ± 14.5). Most of them 41 (87.2%) were in the first four decades of life. Males were predominant 41 (87.2%), with a male to female ratio of 6.8:1. The majority of our patients had blunt abdominal trauma 39 (83%), of whom, road traffic accident accounted for 51.1% and none reported cases of gunshot. Isolated splenic injury was found in 23 (48.9%), and Haemodynamic stability was seen in 27 (57.4%) on presentation. The initial haemoglobin assessment revealed <9 gram/dl in 53.2%. CT scan was performed to 24 (51.1%), of whom 66 patients were Grade I and II and none of our patients were diagnosed as Grade V. Blood transfusion was required in 42 (89.4%). Operative treatment was adopted in 66% (61.7% total splenectomy and 4.3% splenorrhaphy), while selective non-operative management was successful in 16 (34%) of the patients. Higher intra-operative grade of splenic injury was found to be significantly associated with blunt abdominal trauma, haemodynamic instability and associated intra-abdominal injuries. 44 patients (93.6%) were discharged home in a general good condition. The morbidity and mortality were seen in 8.5% and 6.4% respectively. Conclusion: Splenic injuries usually follow blunt abdominal trauma, particularly after road traffic accidents. It is common during the first four decades of life with males being frequently affected. The great success rate of adopting selective non-operative management is worthwhile.
Highlights
The incidence of splenic injury in poly trauma patients was reported to be 44% and combined splenic and hepatic lesions in (18%) [1]
Statistical analysis methods used were frequencies and 95% confidence intervals (CI) for categorical data, mean, standard deviation, frequencies and compared the data, using Student’s t-test and Chi-square tests when appropriate with significance taken at P value < 0.05
Road traffic accident, fall off a height, falling object and other assault accounted for 51.1% 19.1%, 8.5% and 4.3% respectively, Table 2
Summary
The incidence of splenic injury in poly trauma patients was reported to be 44% and combined splenic and hepatic lesions in (18%) [1]. The recent trend in management of splenic trauma is preservation whenever possible This can be non-operative or operative splenorrhaphy [3]. Selective non-operative management (SNOM) of splenic injury is the most common management strategy in haemodynamically stable patient [5,6]. The study was carried over a period from April 2012 to February 2013 It includes all patients, diagnosed as traumatic splenic injury. Operative treatment was adopted in 66% (61.7% total splenectomy and 4.3% splenorrhaphy), while selective non-operative management was successful in 16 (34%) of the patients. Conclusion: Splenic injuries usually follow blunt abdominal trauma, after road traffic accidents. It is common during the first four decades of life with males being frequently affected. The great success rate of adopting selective non-operative management is worthwhile
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