Traumatic Splenic Injury at Al-Yarmouk Teaching Hospital

Abstract

ABSTRACT

Background: Splenic injury can be caused by trauma to the abdomen or lower thorax, which might be blunt or penetrating and may be associated with high morbidity and mortality, depending on mechanism of injury and associated injuries. Different modalities of treatment are present to deal with splenic injuries depending on grade of splenic injury, available resources, experience of the surgeon, and general condition of the patient.

Objectives: To collect the data of patients presented with splenic injury during the period of the study, to document the type of management of such patients.

Methods: This is a prospective study, which included 44 patients admitted to Al-Yarmouk Teaching Hospital between 1\10\2007 and 1/2/2009 with splenic trauma who were analyzed regarding age, gender, mechanism of injury, grades of splenic injury according to classification of the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma (AAST), management of splenic injuries, associated injuries and follow up for morbidity and mortality.

Results: Most patients were males (86.36%), young age group was more frequently injured. 36.36% of patients were in their third decade and 20.4% were in their fourth decade. Penetrating injury was the cause in majority of collected patients( 61.36%). Abdominal pain with abdominal tenderness with or without rigidity were the commonest clinical presentations. Ultrasound scan was positive in 6 patients (13.63%) and CT scan in 4 patients (9%). Diagnostic laparoscopy did not performed to any patient in this study. Grades I, II, and III were more common (forming 61.26% of patients), while the remainder were in grades IV, V and VI. Associated injuries were frequent occurring in (72.72%) of patients and the most common one was liver injury (29.5%), followed by injuries to the chest, stomach, diaphragm, small bowel. Laparatomy was applied to most patients (40, 90.9%) with evident features of acute abdomen. Splenectomy was most commonly performed procedure for splenic injury, (33,75%). Splenorrhaphy was performed in seven patients (15.9%). Drainage of the splenic bed had been done in all patients that were managed operatively. Non operative management was applied to four patients (9%). Pulmonary complications were the commonest complications and occurs in 12 patients (27.27%), followed by abdominal complications 5 patients (11.36%). The mortality rate was 18.18% (8 patients), of which died due to massive associated injuries and high grade splenic injuries.

Conclusion: Splenic injuries were caused mainly by penetrating injuries. Decision for surgical intervention depended mainly on clinical basis. Imaging techniques (CT scan and U/S) were used in limited number of patients due to difficulty to its access. Grading of splenic injuries by using AAST grading system is very useful tool for communication and comparison with other studies. 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. The most common post operative complication was related to the respiratory.

Keywords: Trauma, splenic injury.

Iraqi Medical Journal Vol. 56, No.1, June 2010; p.59-68