Recent Changes in the Management of Blunt Splenic Injury: Effect on Splenic Trauma Patients and Hospital Implications

Abstract

Ann R Coll Surg Engl 2008; 90: 109-112 109Until recently, the accepted treatment for splenic trauma, even for minor injuries, used to be splenectomy. This aggressive approach was based on the belief that, in adulthood, the spleen does not contribute any major function and conservative treatment was associated with potential life-threatening haemorrhage. With increasing recognition of the spleen's role in immunological function and awareness of overwhelming postsplenectomy sepsis (OPSI), there has been an increasing trend towards conservative treatment and splenic salvage procedure. However, this changed policy towards splenic conservation requires careful risk-benefit analysis in the face of potentially life-threatening haemorrhage from delayed splenic rupture and the possibility of transfusion-induced viral infections. Furthermore, the increasing availability of reliable and good quality radiological imaging including ultrasound, computerised tomography (CT) scanning, and magnetic resonance imaging (MRI) have greatly improved the information available with regard to the nature of the splenic injury and this may well help to identify the suitable patients for conservative management, 2 but at the expense of patient radiation.We have reviewed the outcome of splenic injuries from our institution with the main aim of examining the effect of this changed conservative policy on patients and its implications. Patients and MethodsWe have undertaken a retrospective study of patients with blunt splenic injury admitted to our hospital between January 1997 and December 2005. Patients were identified with the help of clinical coding department querying on coding data on PAS (Patient Administration System). Coding data are extracted from various source documentation found in the patient case-note and theatre register. Data regarding patient demography, mode of splenic injury,

Splenic injury: a clinical study and management in a tertiary care hospital

“…15 Arlet et al found 28% of the patient with blunt trauma abdomen presenting with vomiting. 7 In the present series 4 (13.33%) patients presented with shock. Shock was either due to hypovolemia or reflex due to severe pain or apprehension.…”

“…2 Arlet et al found male-female incidence of 77.02% and 22.08% respectively. 7 The higher incidence of splenic trauma in male is due to the fact that, the males are more exposed to trauma because of their outdoor works. But in west this difference is relatively narrow In the present study the most common cause of blunt splenic trauma was found to be motor vehicle accident, accounting for 46.66% of cases.…”

The splenic injury outcomes trial

“…Other risks may result from strategies aimed at splenic preservation, mainly the use of angiography (ANGIO) and embolization (EMBO). Patients may experience exposure to radiation, invasive procedures, and increased costs as a result of guidelines and treatment algorithms aimed at splenic preservation (15,17,18).…”

Splenectomy indications and postoperative follow-up results of a department of general surgery

“…Trauma patients with isolated splenic injuries are the best indication group for the prognosis (33,34). The mortality rate in these patients varies between 2 to 9.3%and the lowest mortality rates are seen after splenectomy due to these indications (35,37).…”