Management Management of Traumatic Ruptured Spleen
Abstract
ABSTRACTBackground: Traumatic splenic injury can be due to blunt or penetrating injuries. Different modalities of treatment are present to deal with splenic injuries depending on the severity of injury, grade of splenic injury, available resources and experience of the surgeon.
Objectives: To study the different types of management in our collection and compare with other published results.
Methods: This prospective study included 44 patients with splenic trauma admitted to Al-Yarmouk Teaching Hospital in the period between 1\10\2007 and 1\2\2009. Data collected included gender, mechanism of injury, grades of injury, management, morbidity and mortality.
Results: Most patients were males (86.4%), young age group was more frequently injured. Penetrating injury was the cause in 61.36% of cases. Due to the heavy casualties in most instances, the decision for the type of treatment was clinical. Grades III, IV and V form 75% of patients. Associated injuries were frequent occurring in 27 (72%) of patients and the most common associated intra-abdominal injury was liver injury (29.5%) while the commonest associated extra-abdominal injury was injuries to the head and chest.
Laparotomy was applied to 40 patients (90.9%) with evident features of acute abdomen. Splenectomy was performed in 33(75%) patients, splenorrhaphy in seven patients (15.9%). Non operative management was applied to four patients (9.1%). Pulmonary complications were the commonest and occurs in 12(27.3%) patients. The mortality rate was 18.2% (8 patients) due to massive associated injuries in most cases.
Conclusion: Splenectomy was the commonest procedure done in our series due to massive casualties and high grades injury of the spleen with high rates of associated injuries. Splenorrhaphy and conservative treatment were still used in small number with success. There was significant rate of mortality in comparison to that in the literature. More spleen salvage procedures can be accomplished in better conditions.
Keywords: Splenectomy, Splenorrhaphy, Conservative, Spleen injury.
Iraqi Medical Journal Vol. 56, No.1, June 2010; p.25-31
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