Palanivel Rajagopal
BACKGROUND
An injured spleen is a well-known entity to those involved in trauma care. The majority of individual with a splenic injury now receive nonoperative intervention and therapy. This shift from operative to nonoperative treatment over the past several decades is a tremendous success story in which clinical judgment and reason triumphed over standard surgical dogma. In emergency room, restoration of airway, breathing and circulation should be focussed on. A careful history is the most important one. Nevertheless, the severity of the splenic injury plays a dominant part in determining whether nonoperative management is appropriate or-if-not-whether splenorrhaphy or splenectomy will be the more appropriate surgical option. As a general rule, younger, healthier patients with lower grade splenic injuries and fewer associated injuries and comorbidities are usually managed nonoperatively or with splenic repair, whether unstable, actively bleeding patients with more severe splenic trauma and/or multiple associated injuries require splenectomy.
The aim of the study is to evaluate-
1. The impact of blunt or penetrating abdominal trauma on spleen.
2. Various modes of injury.
3. Various modes of clinical presentation of cases.
4. The value of various available investigations employed.
5. The various methods of treatment.
6. The morbidity and mortality.
MATERIALS AND METHODS
This study was a prospective study of 20 cases of splenic injury admitted in the triage ward of Mahatma Gandhi Memorial Government Medical College Hospital, Trichy, over a period of 2 years from December 2014 to December 2016. Once the patient is admitted, the name, age, sex and mode of injury are noted. The time interval between splenic injury and admission and time interval between admission to hospital and surgery are recorded. After resuscitating the patient, all patients were subjected to careful clinical examination.
RESULTS
The total number of patients who had sustained splenic injuries were 20. In this study of the 20 patients, 15 cases were males and 5 cases were females. After improving the general condition of the patient, laparotomy proceeded in 12 cases, in which splenectomy done in 8 cases and splenoraphy in 5 cases.
CONCLUSION
Road traffic accident is the commonest cause for splenic injury abdomen. Predominance of male over female in splenic injury abdomen with the ratio of 3:1.People in the age group of 3rdand 4th decade were commonly involved in splenic injury abdomen constituting about 55%. Based upon the grading of injuries and haemodynamic stability of the patient and other associated injuries, decision of laparotomy versus conservative management was taken. 12 patients were managed surgically, 8 underwent splenectomy and 4 underwent splenoraphy by topical haemostatic agents and sutural repair. Overall mortality due to splenic injury abdomen was 15%. Sepsis and associated injury were the major causes of death.
