Management of splenic injuries following blunt abdominal trauma: Our experience
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Management of Splenic Injuries Following Blunt Abdominal Trauma: Our Experience Clinical Study A. Matsou, K. Valsamidis, G. Vrakas, D. Zerva, K. Hatzimisios, K. Saliangas Received 27/12/2010 Accepted 15/01/2010
Abstract
Introduction
Aim - Background: Trends in the management of blunt splenic trauma have shifted over the years from splenectomy to splenic preservation. The Aim of the manuscript is to identify the factors that influence the choice of treatment for spleen trauma. Material-Method: We conducted a retrospective review of the medical records of patients admitted with blunt splenic injury to our regional hospital over a two-year period (2008-2010). Haemodynamic status upon admission, computed tomography grade of splenic tear, presence and severity of associated injuries have been taken into account to determine the treatment of choice. Therapeutic options were classified into non-operative, operative salvage and splenectomy. Results: Fourteen patients (9 males 64.2%) were admitted with blunt splenic trauma. The most common mechanism of injury was motor vehicle accident (MVA) (64.2%). Splenectomy was undertaken in 7 (50%) patients, in 2 (14.3%) operative salvage was achieved and 5 (35.7%) were selected for nonoperative-management (NOM). Grade of splenic injury, concomitant injuries and haemodynamic stability were identified as significant determinants of the form of treatment provided. Conclusions: NOM can be successfully performed for haemodynamically stable patients with blunt splenic trauma. When surgery is indicated, intraoperative salvage should be considered to reduce the incidence of OPSI. Further research should be made into whether splenectomy is overused.
Blunt abdominal trauma is a significant cause of morbidity and mortality with motor vehicle accidents (MVA) and falls constituting the most frequent causes. The second most commonly injured organ after blunt trauma of the abdomen in all age groups is the spleen. According to the American Association for the Surgery of Trauma (AAST) there are five types of splenic injury (Table 1). As seen in the table the injury can be severe, and sometimes lead to haemorrhagic shock since the spleen receives 5% of the total cardiac output, but there are also lower grade splenic injuries that do not cause haemodynamic instability. The treatment of these injuries has undergone significant evolution over the past few decades but optimal management remains a subject of controversy [1-19]. There has been a change in trends from splenectomy for all traumatic injuries, including minor ones, to splenic preservation which includes splenic salvage and conservative management. This transpired after the risk of lifelong susceptibility to overwhelming postsplenectomy infection (OPSI) was identified [2022], a rare but highly fatal syndrome caused by encapsulated organisms that can result in death within 24 hours. Non-operative management (NOM) in adults has achieved success rates ranging from 68% to 83%, and is considered to be the cornerstone of treatment in haemodynamica
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