Vol 39 # 2 June 2007 - Kma.org.kw

KUWAIT MEDICAL JOURNAL June 2007Original ArticleOutcome of Non-operative Management of Blunt SplenicTraumaABSTRACTHayan Abdulrahman Bismar, Saleh Mohammed Al-SalamahDepartment of Surgery, College of Medicine, University Unit,King Saud University, Riyadh Medical Complex, Saudi ArabiaObjective: To evaluate the outcome of non-operativemanagement (NOM) and compare it with the operativetreatment in splenic traumaDesign: Aretrospective comparative studySetting: Riyadh Medical Complex, Riyadh, Kingdom ofSaudi ArabiaSubjects: Files of 83 patients managed for blunt splenictrauma over a five year period were reviewed. Patientswere divided in two groups: operative group and nonoperativegroup.Intervention: Thirty five patients were hemodynamicallyunstable and underwent laparotomy with eithers p l e n e c t o m y, splenorrhaphy or partial splenectomy(operative group). Forty eight patients werehemodynamically stable. The diagnosis of splenic injurywas confirmed on CT abdomen. These were initiallymanaged conservatively by serial clinical and laboratorymonitoring in the intensive care unit (ICU) followed byKuwait Medical Journal 2007, 39 (2):144-148bed rest for 5-7 days in the general ward (non-operativegroup).Main outcome measures: Outcome was compared interms of hospital stay, complications, blood transfusionre q u i rements, morbidity and mortality between twogroups.Results: Among 35 patients (42%) with laparotomy, thespleen was removed in 25 patients and preserved in 10patients. Forty eight patients (58%) were hemodynamicallystable and were treated non-operatively. The nonoperativegroup had a more advanced injury grade,required less blood transfusion and had shorter hospitalstay than the operative group. Non-operative managementfailed in four patients and had a success rate 91.7%.C o n c l u s i o n : NOM of blunt splenic trauma inhemodynamically stable patients is safe and effective. Itresults in shorter hospital stay, low morbidity andmortality.KEY WORDS: blunt splenic trauma, non-operative treatment, splenic preservation, splenectomyINTRODUCTIONEver since Reinger reported the first successfulsplenectomy for splenic injury in 1892 [1] , it hadbecome the standard treatment of traumaticrupture of the spleen. Early in the 20th century,many studies revealed the importance of spleen inthe immunity and the asplenic state putting theperson at lifelong risk of susceptibility toinfection [1,2] . This led to a shift in the managementtowards splenic preservation (splenorrhaphy, meshsplenorrhaphy, or partial splenectomy) followingtrauma in the last few decades [3] . The liberal use ofcomputed tomography (CT) in blunt abdominaltrauma has reduced the rate of non-therapeuticceliotomy, as many cases of splenic injuries can bedetected on CT in hemodynamically stable patientswho could be observed and treated non-operatively [ 4 ] .Non-operative management (NOM) for pediatricblunt splenic trauma was first reported byUpadhyaya in 1968 followed by many studies inthe eighties which reported favorable results ofNOM in pediatric patients [5-8] . At the same timemany investigators have applied the NOM toadults splenic trauma and reported encouragingresults [9-11] . NOM is considered the method of choicein treating blunt splenic injuries in hemodynamicallystable patients in most trauma centersthese days. However, few aspects re m a i nc o n t roversial and need to be evaluated. Thiscomparative study was carried out at the RiyadhMedical Complex to evaluate the outcome andexperience of managing blunt splenic traumabetween operative and non-operative groups.PATIENTS AND METHODSThe medical records of 83 patients with splenicinjuries due to blunt abdominal trauma over a fiveyear period from January 2000 to December 2004w e re re t rospectively reviewed for demographicdata, mechanism of injury, hematological andAddress correspondence to:Dr. Saleh M. Al-Salamah, MBBS, FRCS, Associate Professor and Consultant General Surgeon, College of Medicine King Saud University, Dept.of Surgery, University Unit, Riyadh Medical Complex, P.O. Box 261283, Riyadh 11342, Saudi Arabia. Tel: +9661 467 1585, Fax: 01 467 9493,E-mail: smsalamah@hotmail.com