Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

Abstract

BackgroundSplenic injuries constitute a continuing diagnostic and therapeutic challenge to the trauma or general surgeons practicing in developing countries where sophisticated imaging facilities are either not available or exorbitantly expensive. The purpose of this review was to describe our own experience in the management of the splenic injuries outlining the aetiological spectrum, injury characteristics and treatment outcome of splenic injuries in our local environment and to identify predictors of outcome among these patients.MethodsA prospective descriptive study of splenic injury patients was carried out at Bugando Medical Centre in Northwestern Tanzania between March 2009 and February 2011. Statistical data analysis was done using SPSS software version 17.0.ResultsA total of 118 patients were studied. The male to female ratio was 6.4:1. Their ages ranged from 8 to 74 years with a median age of 22 years. The modal age group was 21-30 years. The majority of patients (89.8%) had blunt trauma and road traffic accidents (63.6%) were the most frequent cause of injuries. Most patients sustained grade III (39.0%) and IV (38.1%) splenic injuries. Majority of patients (86.4%) were treated operatively with splenectomy (97.1%) being the most frequently performed procedure. Postoperative complications were recorded in 30.5% of cases. The overall length of hospital stay (LOS) ranged from 1 day to 120 days with a median of 18 days. Mortality rate was 19.5%. Patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with associated injuries stayed longer in the hospital (P < 0.001), whereas age of the patient, associated injuries, trauma scores (KTS II), grade of splenic injuries, admission systolic blood pressure ≤ 90 mmHg, estimated blood loss > 2000 mls, HIV infection with CD4 ≤ 200 cells/μl and presence of postoperative complications were significantly associated with mortality (P < 0.001).ConclusionTrauma resulting from road traffic accidents (RTAs) remains the most common cause of splenic injuries in our setting. Most of the splenic injuries were Grade III & IV and splenectomy was performed in majority of the cases. Non-operative management can be adopted in patients with blunt isolated and low grade splenic injuries but operative management is still indispensable in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of splenic injuries in our centre.

Animal-related injuries in a resource-limited setting: experiences from a Tertiary health institution in northwestern Tanzania

“…In agreement with other studies [11,18,20], animal related injuries in our series were found to be most common in the third decade of life. High occurrences of animal related injuries among this age group have been attributed to a wide range of activities engaged in by this class of people.…”

“…The outcome of treatment of animal related injuries may be poor especially in developing countries due to late presentation, lack of advanced pre-hospital care system and trauma centers and ineffective ambulance system for transportation of patients from the site if injury to hospital continues to be an area of neglect that prevents optimal trauma care [18]. …”

Patterns and Short Term Outcomes of Chest Injuries at Mbarara Regional Referral Hospital in Uganda

“…Subedi et al 26 found that rib fractures were a good indicator of underlying liver and spleen injuries. Ibenzi et al 27 studied patterns of abdominal injury at Muhimbili Hospital and found chest injury as the second most common associated extra-abdominal injury while Chalya et al 28 in Tanzania also found chest injuries (75%) to be the most common associated injury among patients with splenic injuries.…”

Abdominal trauma in a semi-urban tertiary health institution

“…This is due to its close proximity to the abdomen, and some solid organ injuries may be associated with rib fractures. Chalya et al, however, reported that head injury was the most common associated injury (20,21). The presence of associated injuries has been found to be significantly related to increased length of hospital stay and mortality (21).…”